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Washington rates for HCPCS L8015

External breast prosthesis garment, with mastectomy form, post mastectomy

Facilitymedian $74 · 10th–90th $47$1700%20%10th90th$74Professionalmedian $54 · 10th–90th $31$1290%10%10th90th$54$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $38.02 / $169.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $70.79
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $72.44 / $72.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $46.77
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $91.20 / $208.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $85.11 / $151.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $56.23 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $74.13
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $74.13
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $107.15 / $147.91
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $72.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $83.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $104.71 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $42.66 / $61.66
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $63.10 / $112.20