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Minnesota 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
$126.86 / $126.86 / $126.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.90 / $119.11 / $126.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.74 / $151.46 / $210.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.17 / $143.88 / $151.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $467.62 / $1,298.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.50 / $186.03 / $222.89
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.62 / $448.66 / $1,022.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.50 / $175.50 / $180.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.56 / $151.46 / $705.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.99 / $75.36 / $152.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.99 / $75.50 / $152.09