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Louisiana 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
$39.32 / $41.74 / $59.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.85 / $41.74 / $60.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.32 / $108.17 / $152.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.18 / $51.65 / $51.65
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.33 / $57.33 / $57.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $47.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.29 / $54.62