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New Mexico 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
$110.46 / $110.46 / $110.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.86 / $150.78 / $560.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.96 / $159.94 / $190.58
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 / $120.62 / $120.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.18 / $200.23 / $300.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.30 / $57.30 / $150.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $120.62 / $227.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.07 / $88.76 / $133.74