go back

Oregon 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
$22.54 / $30.13 / $168.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $25.55 / $35.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $93.04 / $121.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.13 / $41.28 / $49.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.84 / $46.56 / $52.01
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.34 / $45.16 / $49.68
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.58 / $49.53 / $49.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.13 / $37.25 / $54.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $43.37 / $54.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.27 / $82.38 / $173.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.60 / $54.48 / $54.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $21.86 / $41.91