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Montana rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.76 / $203.79 / $203.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.45 / $71.45 / $71.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $76.84 / $76.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $62.49 / $76.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $73.18 / $76.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $57.67 / $76.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $32.33 / $58.11