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New Jersey 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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $97.72 / $165.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $208.93 / $288.40
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $194.98 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $102.33 / $162.18