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Maryland rates for HCPCS L8002

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.43 / $95.31 / $155.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.51 / $108.93 / $132.87
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 / $88.05 / $120.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.07 / $194.38 / $279.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.56 / $98.77 / $153.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.55 / $117.55 / $136.07