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Massachusetts rates for HCPCS L8001

Breast Prosthesis Mastectomy Bra With Integratedbreast Prosthesis Form Unilateral Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.58 / $64.58 / $64.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.58 / $64.58 / $117.60
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.66 / $151.57 / $705.18
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.06 / $115.37 / $144.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.09 / $135.91 / $135.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $108.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $175.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.68 / $119.68 / $125.66
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.32 / $85.32 / $85.32
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.45 / $705.18 / $705.18
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.08 / $78.98 / $144.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.52 / $78.98 / $144.35