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Nebraska 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
$96.08 / $96.08 / $96.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.08 / $96.08 / $113.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.43 / $145.66 / $147.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $165.74 / $165.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.15 / $165.74 / $255.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.20 / $158.53 / $705.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.36 / $89.98 / $125.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.25 / $165.74 / $208.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.81 / $195.87 / $341.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.36 / $80.45 / $121.32