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Minnesota rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.62 / $228.62 / $228.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.03 / $223.16 / $228.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.81 / $272.94 / $380.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.35 / $259.29 / $272.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $833.98 / $1,952.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.50 / $335.49 / $401.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.96 / $807.98 / $1,841.68
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.50 / $316.50 / $325.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.88 / $272.94 / $1,269.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.08 / $134.38 / $274.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.08 / $134.33 / $286.58