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Oklahoma 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
$31.21 / $31.21 / $31.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.21 / $35.67 / $36.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.34 / $63.70 / $63.70
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 / $46.82 / $47.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $43.70 / $338.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $41.54 / $71.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $32.79 / $48.69