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South Carolina 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
$23.61 / $236.30 / $236.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $23.61 / $39.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.64 / $52.79 / $65.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.97 / $37.97 / $37.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $44.00 / $63.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.52 / $35.00 / $38.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $29.97 / $35.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.11 / $38.00 / $82.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $33.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.67 / $35.67 / $35.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.22 / $25.76 / $36.79