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Maryland 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
$59.68 / $88.13 / $258.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $23.36 / $39.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.46 / $24.46 / $29.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.00 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $35.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.67 / $43.82 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.50 / $22.62 / $34.67
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.62 / $29.62 / $32.40