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Michigan rates for HCPCS L8031

Breast prosthesis, silicone or equal, with integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.97 / $240.97 / $240.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.81 / $240.97 / $245.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.65 / $1,272.43 / $2,317.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.85 / $421.95 / $569.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.62 / $257.27 / $274.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.56 / $337.56 / $337.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.45 / $277.45 / $277.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.45 / $277.45 / $489.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.97 / $304.92 / $304.92
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.97 / $304.92 / $450.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.43 / $201.72 / $339.62