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Vermont rates for HCPCS L8000

Breast Prosthesis Mastectomy Bra Without Integrated Breast Prosthesis Form Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.53 / $21.78 / $25.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.11 / $36.11 / $36.11
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 / $29.97 / $37.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $35.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $29.97 / $37.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.44 / $26.44 / $51.59