go back

Utah rates for HCPCS L8001

Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.56 / $43.56 / $43.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.56 / $47.89 / $426.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.93 / $98.15 / $98.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.65 / $98.15 / $104.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.28 / $111.75 / $145.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.04 / $149.49 / $149.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.13 / $107.16 / $160.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.93 / $67.48 / $96.57