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Indiana rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $36.31 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $56.23 / $100.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $74.13 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $44.67 / $77.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $91.20 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $46.77 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $63.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $57.54 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $36.31 / $54.95