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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$21.49 / $35.81 / $41.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.87 / $134.88 / $159.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.84 / $51.58 / $67.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.00 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $47.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.91 / $40.34 / $58.73