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South Carolina 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
$32.54 / $32.54 / $32.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $32.54 / $54.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.10 / $65.00 / $79.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $87.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $46.82 / $51.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $45.81 / $47.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $53.00 / $114.25
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $41.00 / $46.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.15 / $49.15 / $49.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.20 / $35.97 / $54.33