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Arizona rates for HCPCS L8002

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $100.00 / $389.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $117.49 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $194.98 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $128.82 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $89.13 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $154.88 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $89.13 / $134.90