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New Mexico 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
$40.13 / $40.13 / $40.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.92 / $54.78 / $203.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.58 / $58.11 / $69.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $46.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $46.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.19 / $72.73 / $109.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $20.87 / $54.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $85.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.89 / $32.33 / $48.71