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Vermont rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $38.02 / $43.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $47.86
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $69.18 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $42.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $48.98 / $147.91