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Missouri 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
$68.84 / $101.82 / $105.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.84 / $78.88 / $143.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.66 / $158.19 / $695.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.29 / $101.55 / $123.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $98.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $71.65 / $104.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.84 / $121.43 / $705.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.24 / $76.23 / $121.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.24 / $75.17 / $121.32