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Wisconsin rates for HCPCS A4280

Adhesive skin support attachment for use with external breast prosthesis, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $6.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $12.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $22.91 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $10.72 / $14.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $5.37 / $7.76
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.59 / $9.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $5.75 / $15.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.72 / $37.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $11.48 / $20.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $33.11 / $37.15
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $3.72 / $6.03