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New Hampshire 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
$25.13 / $25.13 / $30.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $19.57 / $26.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.63 / $44.63 / $52.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.97 / $32.40 / $32.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $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 / $111.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $22.27 / $33.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.16 / $34.99 / $51.44