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Maine rates for HCPCS L8001

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.58 / $99.55 / $99.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.46 / $170.32 / $315.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.36 / $89.36 / $110.95
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 / $71.65 / $98.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.68 / $119.68 / $119.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.56 / $99.54 / $99.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $112.48 / $204.65