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Washington, DC 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
$37.65 / $37.65 / $37.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.65 / $37.65 / $37.65
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $39.43 / $48.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $34.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.92 / $45.92 / $140.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.49 / $35.24 / $49.92