go back

Arkansas rates for HCPCS L8000

Breast Prosthesis Mastectomy Bra Without Integrated Breast Prosthesis Form Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.03 / $25.03 / $25.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $25.03 / $25.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.02 / $36.02 / $36.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.86 / $51.44 / $57.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.82 / $52.79 / $52.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.82 / $43.82 / $68.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $36.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $33.84 / $35.17
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.42 / $41.42 / $41.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.98 / $22.46 / $39.22