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Indiana rates for HCPCS L8001

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $72.08 / $151.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.08 / $73.52 / $75.34
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.60 / $113.60 / $150.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.65 / $135.56 / $151.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.87 / $101.55 / $136.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.18 / $166.61 / $227.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.74 / $166.61 / $204.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $151.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $155.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.99 / $75.56 / $113.81