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Pennsylvania rates for HCPCS L8010

Breast Prosthesis Mastectomy Sleeve (Special Coverage Instructions Apply. See Mcm: 2130 A)

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.75 / $58.33 / $72.19
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.80 / $52.80 / $52.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.75 / $58.33 / $72.19
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.37 / $43.37 / $43.37
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.37 / $43.37 / $43.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00