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Ohio 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
$73.95 / $73.95 / $155.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.08 / $73.95 / $101.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.60 / $113.60 / $113.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.22 / $166.61 / $431.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.87 / $82.73 / $196.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.60 / $151.46 / $204.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.96 / $137.02 / $324.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $178.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $71.65 / $125.39
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $98.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $98.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $75.56 / $118.70