go back

Wisconsin rates for HCPCS L3250

Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each

Facilitymedian $219 · 10th–90th $112$1,1750%10%20%10th90th$219Professionalmedian $135 · 10th–90th $110$3980%20%10th90th$135$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $123.03 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $707.95 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $316.23 / $501.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $173.78 / $426.58
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $501.19 / $676.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $218.78 / $1,174.90
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $346.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $302.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $524.81 / $724.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $416.87 / $1,445.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $309.03 / $1,621.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $158.49 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $245.47