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Idaho 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
$49.55 / $49.55 / $49.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.11 / $41.64 / $48.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $36.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $37.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $37.25 / $49.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.58 / $47.05 / $49.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $36.55 / $43.53
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.37 / $48.37 / $72.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $52.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.21 / $21.86 / $39.29