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Virginia rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.25 / $37.25 / $37.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.49 / $37.25 / $38.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.64 / $70.64 / $75.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.76 / $44.76 / $55.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $39.58 / $48.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $47.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $34.18 / $47.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.45 / $63.58 / $84.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.87 / $43.44 / $80.41
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $92.78 / $117.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.75 / $53.47 / $90.24
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.75 / $53.47 / $90.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.33 / $35.24 / $58.11