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Arizona rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.69 / $131.69 / $131.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.90 / $122.42 / $263.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.80 / $225.80 / $225.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.87 / $237.96 / $430.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.67 / $219.56 / $299.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $170.64 / $179.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $316.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.55 / $174.85 / $1,269.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.07 / $120.12 / $200.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.57 / $120.12 / $180.95