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Utah rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $14.11 / $14.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.11 / $19.71 / $168.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $37.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.03 / $33.09 / $43.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.54 / $44.10 / $44.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.10 / $31.61 / $47.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.73 / $21.86 / $31.36