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Arizona rates for HCPCS L8000

Breast Prosthesis Mastectomy Bra Without Integrated Breast Prosthesis Form Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.53 / $89.28 / $242.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.58 / $26.29 / $168.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.59 / $52.59 / $58.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.34 / $54.72 / $100.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.35 / $51.14 / $69.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $41.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $59.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $39.04 / $230.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.21 / $21.86 / $39.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.76 / $21.86 / $32.93