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Illinois 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
$25.30 / $29.77 / $78.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.57 / $25.30 / $40.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $69.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.80 / $102.22 / $559.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.84 / $51.11 / $51.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $53.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $34.32 / $59.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.44 / $51.11 / $71.55
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.44 / $66.44 / $66.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.65 / $29.50 / $30.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.46 / $25.50 / $43.78