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Wisconsin rates for HCPCS L6915

Hand Restoration (Shading And Measurements Included) Replacement Glove For Above

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.72 / $493.72 / $493.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.72 / $493.72 / $819.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$978.71 / $1,076.58 / $1,781.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.48 / $910.20 / $1,203.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.08 / $2,094.44 / $2,094.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.36 / $2,023.46 / $4,085.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.38 / $1,418.44 / $1,852.29
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.00 / $740.58 / $1,125.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.39 / $969.07 / $1,174.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.91 / $978.71 / $4,034.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.86 / $564.79 / $1,065.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $553.58
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.00 / $740.58 / $1,125.52
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.39 / $969.07 / $1,174.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.71 / $1,468.07 / $2,249.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.36 / $1,911.54 / $4,034.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.38 / $644.36 / $4,651.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.71 / $978.71 / $978.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.71 / $978.71 / $978.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.86 / $499.81 / $839.39