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Tennessee rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.91 / $31.52 / $31.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.86 / $31.52 / $54.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.34 / $65.47 / $65.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.75 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $46.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.20 / $338.32 / $338.32
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.44 / $364.44 / $529.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.20 / $36.29 / $54.33