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Breast Prosthesis, Mastectomy Sleeve

Wisconsin rates for HCPCS L8010

Breast prosthesis, mastectomy sleeve

Rates data updated July 2026.

Facilitymedian $138 · 10th–90th $24$1860%10%10th90th$138Professionalmedian $58 · 10th–90th $50$910%20%10th90th$58$0.5$2.0$10.0$50.0$200.0

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
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$162.18
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$57.54
Typical High
$72.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Medica
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Molina
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$58.88
Quartz
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$69.18
Typical High
$91.20
Quartz
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$181.97
Quartz
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$28.18
Typical High
$45.71