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North Dakota 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
$53.24 / $53.24 / $53.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.24 / $60.61 / $60.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.43 / $80.90 / $82.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.00 / $84.84 / $106.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.85 / $56.63 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.16 / $36.51 / $58.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $36.51 / $72.36