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New Jersey rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.78 / $105.78 / $105.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.78 / $125.27 / $182.34
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.29 / $141.29 / $141.29
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.84 / $223.84 / $223.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $287.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $252.04
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.97 / $264.81 / $377.07
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.00 / $191.00 / $191.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.24 / $149.81 / $287.83