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Wisconsin rates for HCPCS L8043

Upper facial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,289.87 / $2,289.87 / $2,289.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,853.77 / $2,289.87 / $3,802.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,539.22 / $4,993.14 / $8,261.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,085.30 / $4,221.47 / $5,583.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,306.22 / $3,885.62 / $9,713.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,600.52 / $9,384.54 / $18,947.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.44 / $6,683.22 / $8,590.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.88 / $3,434.81 / $5,220.10
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,599.05 / $4,539.22 / $5,447.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,258.80 / $4,539.22 / $21,186.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,044.70 / $3,032.98 / $4,942.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $85.00 / $2,893.39
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.88 / $3,434.81 / $5,220.10
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,599.05 / $4,539.22 / $5,447.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,539.22 / $6,985.72 / $12,127.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,600.52 / $8,865.68 / $21,186.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.44 / $3,600.52 / $23,846.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,539.22 / $4,539.22 / $4,539.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,539.22 / $4,539.22 / $4,539.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.62 / $2,695.00 / $3,893.10