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Arizona 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
$153.18 / $153.18 / $540.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.79 / $36.59 / $173.72
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.64 / $70.64 / $70.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.54 / $66.98 / $121.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.36 / $61.82 / $84.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $50.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $84.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $47.67 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.89 / $32.33 / $53.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.89 / $32.33 / $48.69