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Wisconsin rates for HCPCS L3420

Full Sole And Heel Wedge Between Sole (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.24 / $33.24 / $33.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.45 / $33.24 / $59.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.89 / $72.48 / $119.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.30 / $61.28 / $81.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.40 / $141.00 / $141.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.78 / $145.27 / $275.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.85 / $109.75 / $124.71
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.96 / $49.86 / $75.77
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $64.33 / $79.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.82 / $65.89 / $306.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.76 / $34.52 / $71.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.68 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.96 / $49.86 / $75.77
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $64.33 / $79.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.89 / $101.40 / $176.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.78 / $128.69 / $306.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.85 / $36.78 / $331.67
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.89 / $65.89 / $65.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.62 / $65.89 / $65.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.18 / $94.18 / $94.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.99 / $32.86 / $63.01