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Tennessee 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
$116.27 / $118.55 / $118.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.27 / $119.39 / $203.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.03 / $246.28 / $246.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.17 / $170.64 / $170.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $170.64
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.41 / $1,269.54 / $1,269.54
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.39 / $1,431.39 / $2,158.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.01 / $134.96 / $204.92