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Hawaii rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.38 / $27.38 / $27.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.86 / $60.86 / $60.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $84.29
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.63 / $80.23 / $80.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.64 / $76.63 / $107.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $60.86 / $84.29
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.51 / $61.71 / $72.93