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Idaho 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
$87.10 / $117.49 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $186.21 / $316.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $218.78 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $186.21 / $204.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $186.21 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $169.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $190.55 / $190.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $144.54 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $199.53 / $204.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $117.49 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $134.90