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Ohio rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Facilitymedian $85 · 10th–90th $55$2040%10%10th90th$85Professionalmedian $37 · 10th–90th $30$630%20%40%10th90th$37$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $158.49 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $34.67 / $60.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $77.62 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $44.67 / $95.50
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $61.66 / $87.10
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $46.77
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $46.77 / $47.86
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $46.77
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $48.98 / $69.18
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $83.18 / $151.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $58.88 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $35.48 / $56.23