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Wisconsin rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.78 / $95.33 / $252.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.99 / $25.78 / $46.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.11 / $56.22 / $93.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.20 / $47.53 / $62.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.77 / $61.33 / $109.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.11 / $53.67 / $73.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.32 / $106.00 / $212.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $74.06 / $96.73
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $38.67 / $58.78
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.26 / $51.11 / $61.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.43 / $51.11 / $230.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $34.00 / $61.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.51 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $38.67 / $58.78
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.26 / $51.11 / $61.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.11 / $78.66 / $131.47
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $99.82 / $230.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $314.95
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.11 / $51.11 / $51.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.81 / $51.11 / $51.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.22 / $30.67 / $43.83