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Maine 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
$30.05 / $264.32 / $413.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $30.06 / $30.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.69 / $51.43 / $95.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.97 / $28.97 / $33.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.30 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $35.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.13 / $36.13 / $36.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$264.32 / $264.32 / $413.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $30.05 / $30.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $32.94 / $51.20