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Wisconsin rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,044.52 / $2,044.52 / $2,044.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.15 / $2,044.52 / $3,394.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,052.87 / $4,458.16 / $7,376.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,634.05 / $3,769.17 / $4,985.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,166.26 / $3,469.30 / $8,673.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,214.74 / $8,378.95 / $16,916.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.53 / $5,966.94 / $7,670.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.07 / $3,066.78 / $4,660.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.57 / $4,052.87 / $4,863.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,016.78 / $4,052.87 / $18,916.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,825.62 / $2,708.01 / $4,413.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $85.00 / $2,583.37
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.07 / $3,066.78 / $4,660.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.57 / $4,052.87 / $4,863.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,052.87 / $6,237.23 / $10,828.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,214.74 / $7,915.76 / $18,916.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.53 / $3,214.74 / $21,291.26
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,052.87 / $4,052.87 / $4,052.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,052.87 / $4,052.87 / $4,052.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,614.61 / $2,406.23 / $3,593.34