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Wisconsin rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.69 / $137.69 / $137.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.99 / $137.69 / $230.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.94 / $300.23 / $496.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.83 / $253.83 / $335.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.36 / $584.09 / $584.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $564.73 / $1,139.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $395.63 / $516.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.55 / $206.54 / $313.88
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.29 / $250.89 / $327.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.24 / $272.94 / $1,269.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.78 / $181.56 / $297.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $164.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.55 / $206.54 / $313.88
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.29 / $250.89 / $327.52
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.94 / $420.05 / $720.66
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $533.08 / $1,269.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $170.64 / $1,431.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.94 / $272.94 / $272.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.95 / $272.94 / $272.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.57 / $158.74 / $272.94