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Maryland 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
Professional
Modifier
Low / Median / High Price
$30.31 / $34.64 / $56.48
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $39.43 / $48.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $47.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.45 / $70.64 / $101.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.82 / $35.39 / $55.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.79 / $43.79 / $49.45