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Arizona rates for HCPCS L8001

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.51 / $68.09 / $113.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.81 / $140.19 / $253.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.01 / $129.35 / $176.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.15 / $98.15 / $98.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $71.65 / $175.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.56 / $98.74 / $705.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $67.48 / $112.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $67.48 / $101.65