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South Carolina 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
$68.09 / $68.09 / $68.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.31 / $68.09 / $113.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.76 / $102.76 / $102.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $110.76 / $165.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.54 / $98.15 / $108.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $91.55 / $98.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.73 / $110.00 / $239.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $97.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.24 / $75.27 / $113.70