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Louisiana 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
$24.34 / $25.83 / $36.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.61 / $25.83 / $37.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.59 / $39.60 / $45.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.19 / $66.95 / $94.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.39 / $45.02 / $45.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.16 / $30.16 / $30.16
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 / $29.97 / $35.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.58 / $22.46 / $35.25