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Indiana 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
Facility
Modifier
Low / Median / High Price
$34.44 / $34.44 / $75.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.44 / $35.11 / $36.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.16 / $64.76 / $72.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.29 / $44.76 / $60.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.56 / $79.59 / $108.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.51 / $79.59 / $97.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $72.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $74.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.10 / $54.33