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Minnesota rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $38.02 / $60.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $72.44 / $107.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $269.15 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $95.50 / $107.15
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $269.15 / $512.86
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $114.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $72.44 / $131.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $34.67 / $72.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $42.66 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $36.31 / $83.18