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Washington, DC 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
$23.36 / $23.36 / $23.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.36 / $23.36 / $23.36
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.46 / $24.46 / $24.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $25.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.48 / $28.48 / $86.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.58 / $21.86 / $30.97