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South Carolina 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
$89.59 / $89.59 / $89.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.59 / $89.59 / $149.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $147.68 / $213.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.82 / $120.62 / $133.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $120.43 / $120.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.12 / $144.00 / $314.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.00 / $112.00 / $127.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $99.02 / $149.53