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Wisconsin rates for HCPCS L3540

Orthopedic Shoe Addition Sole Full (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.91 / $30.91 / $30.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $30.91 / $55.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.29 / $67.42 / $111.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $57.00 / $75.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.09 / $131.16 / $131.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.72 / $135.25 / $256.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.81 / $88.59 / $115.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.64 / $46.37 / $70.48
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.10 / $59.84 / $73.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.54 / $61.29 / $285.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.77 / $32.10 / $66.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.67 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.64 / $46.37 / $70.48
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.10 / $59.84 / $73.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.29 / $94.32 / $163.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.72 / $119.70 / $285.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.81 / $36.72 / $308.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.29 / $61.29 / $61.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.94 / $61.29 / $61.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.39 / $30.58 / $58.60