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Iowa rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.24 / $60.61 / $60.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $38.92 / $61.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $79.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $84.00 / $105.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.52 / $72.36 / $84.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.91 / $93.59 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $46.26 / $98.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.95 / $79.19 / $98.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $92.50 / $151.35
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.62 / $147.62 / $147.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.42 / $43.10 / $94.35
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.55 / $70.55 / $70.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.73 / $70.55 / $70.55