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Wisconsin rates for HCPCS L3360

Sole Wedge Outside Sole (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.64 / $21.64 / $21.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.49 / $21.64 / $38.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.90 / $47.19 / $78.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.10 / $39.90 / $52.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.86 / $91.81 / $91.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.67 / $95.17 / $179.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.47 / $62.34 / $81.19
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.34 / $32.46 / $49.34
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.57 / $41.88 / $51.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.37 / $42.90 / $199.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $22.47 / $46.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.67 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.34 / $32.46 / $49.34
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.57 / $41.88 / $51.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.90 / $66.03 / $114.42
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.67 / $83.78 / $199.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.47 / $26.67 / $215.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.90 / $42.90 / $42.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.26 / $42.90 / $42.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.97 / $21.40 / $40.88