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Michigan rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.32 / $108.11 / $157.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.33 / $41.32 / $41.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.52 / $218.21 / $397.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.73 / $72.36 / $97.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.92 / $47.03 / $47.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.89 / $57.89 / $57.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $46.82 / $84.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.06 / $52.29 / $157.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.43 / $52.29 / $75.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.91 / $53.55 / $61.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.94 / $34.60 / $54.33