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Massachusetts 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
$19.50 / $19.50 / $69.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.25 / $19.50 / $37.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.83 / $103.75 / $277.54
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.84 / $34.83 / $43.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.37 / $57.63 / $74.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $38.88 / $38.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.83 / $31.30 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $59.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.13 / $36.13 / $37.94
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
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.75 / $277.54 / $277.54
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.45 / $23.86 / $43.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $23.86 / $43.58