go back

Hawaii 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
Professional
Modifier
Low / Median / High Price
$25.96 / $25.96 / $25.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.11 / $56.11 / $56.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $46.82 / $77.70
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.64 / $73.97 / $73.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.45 / $70.64 / $98.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.22 / $56.11 / $77.70
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.89 / $50.00 / $67.23