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Nebraska rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.96 / $83.97 / $631.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.96 / $30.96 / $55.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.40 / $36.40 / $36.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.67 / $46.93 / $47.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $53.41 / $53.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $53.41 / $82.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.61 / $53.14 / $230.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $30.04 / $51.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.25 / $53.41 / $67.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.00 / $63.12 / $110.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $28.89 / $39.29