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Minnesota 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
$166.82 / $166.82 / $166.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.95 / $156.68 / $166.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.61 / $199.17 / $277.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.34 / $189.21 / $199.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $614.52 / $1,706.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $244.86 / $293.37
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.83 / $589.60 / $1,343.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $231.00 / $237.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.30 / $199.17 / $927.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.18 / $99.12 / $200.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.18 / $99.12 / $200.01