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Wisconsin rates for HCPCS L8415

Prosthetic Sheath Upper Limb Each (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.98 / $12.98 / $12.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $12.98 / $21.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.73 / $28.30 / $46.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.15 / $23.93 / $31.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.51 / $55.06 / $55.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $53.47 / $107.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.91 / $37.50 / $48.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.27 / $19.47 / $29.59
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $25.73 / $30.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.98 / $25.73 / $134.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.96 / $17.19 / $29.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.27 / $19.86 / $29.59
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.73 / $25.73 / $30.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.73 / $39.57 / $77.28
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $50.26 / $134.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.91 / $16.30 / $161.27
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.73 / $25.73 / $25.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.73 / $25.73 / $25.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $15.44 / $25.73