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Minnesota 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
$60.61 / $60.61 / $60.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $56.19 / $60.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $72.36 / $100.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.89 / $68.73 / $72.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $223.46 / $620.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $89.04 / $106.68
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.66 / $214.40 / $488.70
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $84.00 / $86.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.50 / $72.36 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.17 / $72.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.10 / $94.07