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Iowa 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
$146.50 / $166.82 / $166.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.43 / $106.86 / $168.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $120.62 / $218.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.62 / $231.00 / $288.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.02 / $198.62 / $206.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.02 / $257.70 / $927.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.77 / $127.02 / $270.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.42 / $218.06 / $270.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.58 / $254.72 / $416.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.49 / $117.30 / $233.31
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.28 / $194.28 / $194.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.47 / $194.28 / $194.28