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Indiana rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.33 / $303.74 / $11,458.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.33 / $24.81 / $26.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.33 / $38.33 / $72.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $45.74 / $51.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.92 / $32.40 / $43.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.82 / $56.22 / $76.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.11 / $61.33 / $73.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $51.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $52.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.58 / $25.50 / $36.13