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Washington rates for HCPCS L8002

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

Facilitymedian $195 · 10th–90th $126$4470%20%10th90th$195Professionalmedian $141 · 10th–90th $87$2820%20%10th90th$141$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $107.15 / $173.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $190.55 / $190.55
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $120.23
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $251.19 / $549.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $229.09 / $407.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $147.91 / $162.18
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $190.55 / $194.98
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $194.98 / $199.53
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $281.84 / $389.05
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $190.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $218.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $288.40 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $169.82
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $295.12