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Vermont rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.50 / $117.50 / $135.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.80 / $194.80 / $194.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $176.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $149.90 / $181.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $170.64 / $176.97
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $149.90 / $181.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.08 / $180.95 / $278.36