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New Hampshire rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.58 / $135.58 / $162.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.20 / $134.10 / $162.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.78 / $240.78 / $285.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.08 / $180.77 / $180.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $170.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $176.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.94 / $194.94 / $601.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.08 / $120.12 / $183.82
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.32 / $173.05 / $220.25