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West Virginia 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
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $72.44 / $125.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $204.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $93.33 / $123.03