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Massachusetts 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
$30.86 / $30.86 / $30.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.96 / $30.86 / $56.19
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.72 / $144.25 / $338.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.85 / $55.13 / $68.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.13 / $91.22 / $117.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.63 / $61.54 / $61.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $51.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $84.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $57.18 / $60.04
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $39.92 / $39.92
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.88 / $338.32 / $338.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.19 / $37.75 / $68.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.89 / $37.75 / $68.98