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Wisconsin rates for HCPCS L3630

Transfer Of An Orthosis From One Shoe To Another Solid Stirrup New (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.07 / $61.07 / $61.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.79 / $61.07 / $108.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.06 / $133.16 / $220.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.59 / $112.59 / $148.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.09 / $259.07 / $259.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.56 / $267.48 / $505.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.33 / $175.31 / $229.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.83 / $91.61 / $139.22
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.31 / $118.15 / $145.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.29 / $121.06 / $563.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.86 / $63.42 / $131.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.83 / $91.61 / $139.22
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.31 / $118.15 / $145.27
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.06 / $186.32 / $324.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.56 / $236.44 / $563.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.33 / $67.58 / $609.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.06 / $121.06 / $121.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.67 / $121.06 / $121.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.23 / $60.40 / $121.06