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Montana 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
$122.96 / $426.46 / $426.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.49 / $149.49 / $149.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $160.72 / $160.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.15 / $130.71 / $160.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.42 / $153.08 / $160.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.15 / $120.64 / $160.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.99 / $67.48 / $121.32