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Washington, DC rates for HCPCS L8002

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.61 / $103.61 / $103.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.61 / $103.61 / $103.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.51 / $108.93 / $132.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $88.05 / $88.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.35 / $126.35 / $385.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.65 / $96.97 / $165.74