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Pennsylvania rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.54 / $31.54 / $122.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.96 / $33.40 / $44.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.78 / $70.64 / $70.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $70.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $61.85
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.98 / $70.64 / $134.22
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.69 / $47.69 / $52.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.54 / $31.54 / $122.06
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $34.64 / $75.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.00 / $280.00 / $280.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.60 / $100.70 / $139.19
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $70.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $84.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.50 / $67.23 / $67.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.50 / $67.23 / $68.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.91 / $38.29 / $63.70