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Maine rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.20 / $162.16 / $162.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.15 / $277.45 / $514.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.08 / $159.08 / $180.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.81 / $170.64 / $176.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $170.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.94 / $194.94 / $194.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.58 / $162.16 / $162.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.56 / $180.98 / $276.24