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Wisconsin rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,231.11 / $2,231.11 / $2,231.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,852.39 / $2,231.11 / $3,737.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,422.75 / $4,865.03 / $8,049.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,980.47 / $4,113.16 / $5,439.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,181.72 / $9,464.69 / $9,464.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $9,143.49 / $18,460.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $7,365.95 / $8,370.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.51 / $3,346.67 / $5,086.16
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,532.37 / $4,316.78 / $5,307.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,202.77 / $4,422.75 / $20,671.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,992.25 / $2,955.17 / $4,815.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.51 / $3,346.67 / $5,086.16
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,532.37 / $4,316.78 / $5,307.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,422.75 / $6,806.48 / $11,826.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $8,638.18 / $20,671.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $3,060.59 / $22,266.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,422.75 / $4,422.75 / $4,422.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,422.75 / $4,422.75 / $4,422.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,761.97 / $2,604.69 / $3,921.28