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Maine rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $36.31 / $109.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $83.18 / $95.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $46.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $74.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $43.65 / $109.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $42.66 / $42.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $48.98 / $67.61