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Illinois rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.99 / $53.99 / $166.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.54 / $35.81 / $61.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.69 / $97.69 / $97.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.78 / $145.26 / $792.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.99 / $72.36 / $72.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $79.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $84.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.12 / $76.44 / $98.49
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.07 / $94.07 / $94.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $25.00 / $26.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.55 / $36.10 / $61.66