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Montana rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,590.93 / $12,455.00 / $12,455.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,366.46 / $4,366.46 / $4,366.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $4,694.82 / $4,694.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.59 / $4,694.82 / $4,694.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,202.77 / $4,471.26 / $4,694.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,477.33 / $3,601.76 / $4,698.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,781.51 / $1,971.11 / $3,037.41