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Wisconsin rates for HCPCS L4387

Walking Boot Non-Pneumatic With Or Without Joints With Or Without Interface Material Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.58 / $79.80 / $199.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $106.85 / $173.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.04 / $210.14 / $347.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.67 / $177.67 / $234.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.43 / $229.25 / $408.83
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $200.59 / $268.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.81 / $403.76 / $797.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $277.02 / $361.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.37 / $152.09 / $219.70
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.43 / $191.04 / $229.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.64 / $191.04 / $889.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.82 / $106.86 / $213.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $93.18
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.37 / $152.83 / $219.70
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.43 / $191.04 / $229.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $293.99 / $510.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.81 / $373.12 / $889.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $120.81 / $961.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $191.04 / $191.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.04 / $191.04 / $191.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.79 / $99.32 / $182.67