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Wisconsin rates for HCPCS L5000

Partial Foot Shoe Insert With Longitudinal Arch Toe Filler (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $349.02 / $349.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.61 / $349.02 / $579.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.87 / $761.06 / $1,259.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.39 / $643.44 / $851.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.73 / $1,480.60 / $1,480.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.90 / $1,430.59 / $2,887.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.73 / $1,152.28 / $1,309.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.32 / $523.53 / $795.65
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.14 / $691.87 / $830.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.10 / $691.87 / $3,120.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.64 / $455.84 / $753.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $409.25
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.32 / $523.53 / $795.65
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.14 / $691.87 / $830.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.87 / $1,064.74 / $1,815.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.90 / $1,351.30 / $3,120.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.73 / $459.90 / $4,002.47
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.87 / $691.87 / $691.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.87 / $691.87 / $691.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.44 / $415.12 / $691.87