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Oregon 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
$65.95 / $89.90 / $426.46
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 / $98.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.47 / $286.20 / $373.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.90 / $123.16 / $147.81
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.89 / $138.94 / $155.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.30 / $147.81 / $162.59
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.03 / $147.81 / $153.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.90 / $123.16 / $162.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $129.43 / $162.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.15 / $245.80 / $518.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.12 / $162.59 / $162.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.48 / $67.48 / $128.76