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Virginia rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,276.67 / $2,276.67 / $2,300.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,102.41 / $2,276.67 / $2,372.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,316.77 / $4,316.77 / $4,584.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,699.26 / $2,699.26 / $3,374.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,409.89 / $2,409.89 / $2,950.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $3,060.59 / $3,060.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $2,234.23 / $2,884.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,021.74 / $3,885.09 / $5,180.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.51 / $2,654.90 / $4,843.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.00 / $5,670.10 / $7,190.35
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,365.03 / $3,257.84 / $5,151.99
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,365.03 / $3,257.84 / $5,151.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.45 / $2,153.59 / $3,089.60