go back

Utah 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
$20.87 / $20.87 / $20.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.87 / $22.88 / $203.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.11 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $49.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $53.42 / $69.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.08 / $71.45 / $71.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.69 / $51.23 / $76.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.19 / $32.33 / $46.26