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Alabama rates for HCPCS L8015

External Breast Prosthesis Garment With Mastectomy Form Post Mastectomy (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.15 / $61.15 / $61.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.06 / $61.15 / $61.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.60 / $58.60 / $58.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $72.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $63.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.29 / $54.62