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Minnesota 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
$42.81 / $42.81 / $42.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $32.85 / $42.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.79 / $51.11 / $71.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.89 / $48.55 / $51.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $157.25 / $436.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.25 / $62.81 / $75.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.36 / $150.88 / $343.90
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.25 / $59.25 / $60.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.53 / $51.11 / $230.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $32.94 / $75.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.58 / $22.52 / $51.33