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Wisconsin rates for HCPCS L3570

Orthopedic Shoe Addition Special Extension To Instep (Leather With Eyelets) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.80 / $51.80 / $51.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.03 / $51.80 / $93.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.69 / $112.96 / $186.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.81 / $95.50 / $126.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.88 / $219.76 / $219.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.65 / $226.42 / $428.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $148.59 / $194.34
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.54 / $77.70 / $118.09
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.80 / $100.25 / $123.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.14 / $102.69 / $478.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.84 / $53.80 / $111.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.62 / $60.52 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.54 / $77.70 / $118.09
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.80 / $100.25 / $123.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.69 / $158.05 / $275.01
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.65 / $200.56 / $478.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $69.65 / $516.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.69 / $102.69 / $102.69
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.69 / $102.69 / $102.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.84 / $51.23 / $97.86