go back

Wisconsin rates for HCPCS L3540

Orthopedic shoe addition, sole, full

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $32.36 / $52.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $144.54 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $89.13 / $117.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $50.12 / $77.62
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $87.10 / $109.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $61.66 / $288.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $32.36 / $69.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $58.88 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $93.33 / $169.82
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $123.03 / $288.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $53.70 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $31.62 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $30.90 / $52.48