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Nebraska 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
$126.42 / $126.42 / $126.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.42 / $126.42 / $149.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.22 / $191.65 / $193.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $218.06 / $218.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.62 / $218.06 / $336.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.93 / $201.65 / $927.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.47 / $118.35 / $164.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.42 / $218.06 / $274.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.00 / $257.70 / $449.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.47 / $98.90 / $159.58