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West Virginia 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
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $97.72 / $169.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $269.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $123.03 / $162.18