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Oklahoma 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
$65.31 / $65.31 / $65.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.31 / $74.64 / $75.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.70 / $133.29 / $133.29
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 / $98.15 / $98.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.56 / $91.43 / $705.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.99 / $86.93 / $150.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.99 / $68.63 / $101.65