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Vermont 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 / $34.47 / $39.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $51.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $40.36 / $49.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $46.82 / $51.91
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $49.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.43 / $53.08 / $81.65