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Wyoming rates for HCPCS L8020

Breast Prosthesis Mastectomy Form (Special Coverage Instructions Apply. See Mcm: 2130 A)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.39 / $120.39 / $210.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.14 / $235.14 / $235.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.14 / $235.14 / $235.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.64 / $170.64 / $314.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.57 / $124.57 / $170.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.57 / $122.78 / $215.96