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Vermont rates for HCPCS L8002

Breast Prosthesis Mastectomy Bra With Integratedbreast Prosthesis Form Bilateral Any Size Any Type (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.85 / $94.85 / $109.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $120.62 / $142.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $110.99 / $128.59
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.62 / $120.62 / $142.87
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.05 / $120.62 / $128.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.23 / $120.26 / $224.72