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Maryland rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.99 / $147.25 / $223.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.00 / $168.28 / $205.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $170.64 / $179.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $170.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.19 / $300.29 / $432.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.78 / $154.72 / $237.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.69 / $162.69 / $209.28