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Vermont rates for HCPCS L8002

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $107.15 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $134.90 / $407.38