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Alaska rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.85 / $61.85 / $61.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $46.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $49.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $20.87 / $20.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.11 / $69.69 / $105.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.54 / $68.98 / $68.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $20.87 / $46.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $47.54 / $69.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.14 / $35.24 / $67.54