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Vermont rates for HCPCS L8001

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $81.28 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $97.72 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $97.72
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $144.54 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $102.33 / $309.03