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Maine rates for HCPCS L8001

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $75.86 / $229.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $173.78 / $199.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $97.72 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $97.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $154.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $93.33 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $89.13 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $102.33 / $141.25