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Wisconsin rates for HCPCS L8010

Breast Prosthesis Mastectomy Sleeve (Special Coverage Instructions Apply. See Mcm: 2130 A)

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.72 / $109.52 / $168.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.54 / $56.30 / $72.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.96 / $146.91 / $146.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.36 / $194.36 / $194.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $58.40 / $58.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.67 / $65.47 / $85.01
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.88 / $52.88 / $146.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.98 / $142.15 / $194.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00