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New Hampshire 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
$83.21 / $83.21 / $99.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.31 / $66.01 / $83.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.81 / $147.81 / $175.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.36 / $101.55 / $101.55
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.68 / $119.68 / $369.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.16 / $73.73 / $105.77
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.56 / $106.22 / $135.18