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North Carolina rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.15 / $54.15 / $109.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $54.15 / $54.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.32 / $69.98 / $132.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.64 / $54.56 / $58.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $84.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $54.15 / $81.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $41.00 / $54.67
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.80 / $84.80 / $130.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.89 / $36.29 / $56.94
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.56 / $338.32 / $338.32
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.44 / $364.44 / $529.79