go back

North Carolina rates for HCPCS L8020

Breast Prosthesis Mastectomy Form (Special Coverage Instructions Apply. See Mcm: 2130 A)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.67 / $203.67 / $413.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.90 / $203.67 / $203.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.38 / $263.26 / $499.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.71 / $205.23 / $218.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.87 / $170.64 / $170.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $170.64 / $316.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.55 / $203.67 / $305.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.00 / $154.00 / $192.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $345.40 / $531.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.89 / $137.10 / $215.96
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.54 / $1,269.54 / $1,269.54
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.39 / $1,431.39 / $2,158.80