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Nebraska rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.34 / $182.34 / $182.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.34 / $182.34 / $230.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.31 / $276.44 / $279.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $314.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.64 / $314.52 / $484.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.24 / $309.98 / $1,269.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.86 / $160.16 / $237.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.61 / $314.52 / $396.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.51 / $367.40 / $647.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.86 / $142.63 / $215.96