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Maine 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
$47.57 / $47.57 / $55.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.86 / $47.57 / $47.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.83 / $81.40 / $150.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.81 / $42.81 / $53.03
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 / $34.18 / $46.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $57.18 / $57.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.68 / $55.68 / $55.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.87 / $47.57 / $47.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.91 / $48.71 / $81.04