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Louisiana 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
$108.22 / $114.88 / $163.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.67 / $114.88 / $166.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.28 / $297.73 / $418.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.86 / $142.16 / $142.16
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $120.62 / $120.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $120.62 / $120.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.18 / $99.89 / $156.72