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Connecticut 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
$34.33 / $34.33 / $34.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.74 / $31.85 / $34.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.75 / $70.64 / $80.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.81 / $44.76 / $44.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $46.82
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.92 / $45.92 / $45.92
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.92 / $45.92 / $64.98
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $39.92 / $39.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.89 / $35.24 / $53.78