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Washington rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,805.28 / $6,367.99 / $6,648.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,235.63 / $2,805.28 / $6,648.51
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,779.93 / $8,220.44 / $20,671.75
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,151.25 / $3,777.70 / $22,266.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $3,060.59 / $3,060.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $2,234.23 / $3,060.59
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,485.66 / $4,316.78 / $11,311.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.39 / $4,368.76 / $8,384.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $4,316.78 / $4,316.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,426.56 / $4,215.60 / $4,471.26
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,100.93 / $4,316.78 / $4,471.26
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,779.93 / $4,847.95 / $8,431.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,108.78 / $4,215.60 / $4,215.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,429.31 / $3,669.26 / $4,748.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,889.95 / $2,884.35 / $3,760.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,699.26 / $3,669.26 / $3,669.26