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Massachusetts 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
$84.93 / $84.93 / $84.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $84.93 / $154.72
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.89 / $199.31 / $927.48
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.91 / $151.71 / $189.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.55 / $178.74 / $178.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $120.62 / $142.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $120.62 / $231.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.38 / $157.38 / $165.25
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.32 / $927.48 / $927.48
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.34 / $103.90 / $189.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.42 / $103.90 / $189.82