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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
$36.31 / $47.86 / $107.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $63.10 / $77.62
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $70.79 / $138.04
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $70.79 / $138.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $67.61 / $104.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $77.62 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $40.74 / $42.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $32.36 / $51.29