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Missouri rates for HCPCS L8002

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.57 / $133.96 / $138.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.57 / $103.77 / $188.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.24 / $208.15 / $915.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.17 / $121.56 / $163.04
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 / $128.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.57 / $159.75 / $927.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.97 / $100.28 / $159.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.97 / $98.90 / $145.69