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Idaho 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
$89.90 / $124.25 / $124.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.69 / $98.15 / $98.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $104.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.56 / $104.10 / $147.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.03 / $140.41 / $147.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $109.08 / $129.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.43 / $144.35 / $216.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.47 / $107.16 / $155.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $67.48 / $121.32