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Vermont rates for HCPCS L8001

Breast Prosthesis Mastectomy Bra With Integratedbreast Prosthesis Form Unilateral Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.12 / $72.12 / $83.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.59 / $119.59 / $119.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $108.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $84.08 / $104.64
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $108.61
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $104.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.13 / $87.54 / $170.84