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Wisconsin rates for HCPCS L3455

Heel New Leather Standard (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.74 / $24.74 / $24.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.42 / $24.74 / $44.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.04 / $53.94 / $89.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.61 / $45.61 / $60.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.29 / $104.95 / $104.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.38 / $108.20 / $204.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $81.68 / $92.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $37.11 / $56.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $47.87 / $58.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.43 / $49.04 / $228.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.42 / $25.69 / $53.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.21 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $37.11 / $56.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.09 / $47.87 / $58.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.04 / $75.48 / $131.47
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.38 / $95.78 / $228.34
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $27.38 / $246.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.04 / $49.04 / $49.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.04 / $49.04 / $49.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.11 / $24.47 / $43.48