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Washington, DC rates for HCPCS L8001

Breast Prosthesis Mastectomy Bra With Integratedbreast Prosthesis Form Unilateral Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.79 / $78.79 / $78.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $78.79 / $78.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.50 / $82.84 / $101.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $71.65 / $71.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.08 / $96.08 / $293.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.16 / $73.73 / $104.47