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Connecticut 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
$21.69 / $72.27 / $968.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $21.69 / $26.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.59 / $44.63 / $51.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.97 / $32.40 / $32.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $35.00
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.01 / $29.01 / $29.01
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.20 / $29.01 / $40.68
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.39 / $33.39 / $68.34
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.17 / $34.17 / $34.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $22.27 / $33.97