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West Virginia 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
$34.64 / $34.64 / $34.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.33 / $34.64 / $37.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.28 / $95.36 / $123.62
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.92 / $50.92 / $87.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.82 / $47.76 / $85.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.18 / $46.82 / $348.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.03 / $45.15 / $58.73