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Idaho rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.61 / $61.66 / $61.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.30 / $46.82 / $46.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $49.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $55.07 / $73.36
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.02 / $69.69 / $73.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $54.13 / $64.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.23 / $71.64 / $107.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.35 / $51.35 / $77.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.89 / $32.33 / $58.11