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Washington, DC rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $34.67 / $169.82
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $48.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $50.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $102.33 / $141.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $35.48 / $53.70