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Indiana rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.90 / $129.90 / $272.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.90 / $133.27 / $145.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.71 / $204.71 / $204.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.62 / $244.28 / $272.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.15 / $180.77 / $244.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.23 / $300.23 / $409.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.00 / $300.23 / $368.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $272.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $170.64 / $279.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.08 / $136.16 / $215.96