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Wisconsin rates for HCPCS L3265

Plastazote Sandal, Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.82 / $6.82 / $6.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.82 / $8.14 / $12.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.73 / $26.62 / $26.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.71 / $10.71 / $10.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $40.00 / $55.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.38 / $22.97 / $28.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $10.23 / $15.85
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.82 / $14.86 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.84 / $10.60 / $17.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $10.23 / $15.85
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.19 / $31.55 / $40.97
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.48 / $25.48 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.91 / $28.65 / $93.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.12 / $22.04 / $22.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.81 / $8.66 / $15.29