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Kansas 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
$54.13 / $54.13 / $54.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.87 / $37.69 / $60.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.65 / $61.74 / $65.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.83 / $64.83 / $64.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $46.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $105.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $57.00 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $38.47 / $91.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.94 / $35.92 / $54.33