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North Dakota 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
$112.20 / $112.20 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $81.28 / $125.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $218.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $125.89 / $707.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $75.86 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $218.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $75.86 / $162.18