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New Hampshire rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.77 / $39.77 / $47.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.74 / $31.54 / $39.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.64 / $70.64 / $83.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.81 / $44.76 / $44.76
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 / $34.18 / $49.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $57.18 / $176.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.49 / $35.24 / $48.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.15 / $55.38 / $81.41