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Rhode Island 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
$60.24 / $60.24 / $60.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $25.30 / $26.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $85.22 / $100.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.44 / $34.94 / $42.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.83 / $29.97 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $29.97 / $35.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.84 / $25.49 / $37.11