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Washington rates for HCPCS L8010

Breast prosthesis, mastectomy sleeve

Insurance Carrier
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $146.91 / $146.91
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.93 / $194.36 / $241.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.75 / $61.22 / $73.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.65 / $55.61 / $55.61
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.93 / $37.93 / $37.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00