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Nebraska 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
$45.91 / $45.91 / $45.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.91 / $45.91 / $45.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.99 / $53.99 / $53.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.27 / $69.59 / $70.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $79.19 / $79.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $79.19 / $122.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.25 / $78.05 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.41 / $43.10 / $59.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.95 / $79.19 / $99.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.00 / $93.59 / $163.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.41 / $38.54 / $58.11