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Breast Prosthesis, Mastectomy Form

Indiana rates for HCPCS L8020

Breast prosthesis, mastectomy form

Rates data updated July 2026.

How much does Breast Prosthesis, Mastectomy Form cost?

$141

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $141 for this service. The price depends on where it is billed: about $135 from a physician practice, and about $275 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$135$129 to $182
FacilityA hospital or hospital-owned outpatient department$275$182 to $275

How much rates vary

Facilitymedian $275 · 10th to 90th $129 to $347Professionalmedian $135 · 10th to 90th $115 to $245
$1.0$10.0$100.0$1.0Kfacility $275professional $135

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$131.83
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$275.42
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$275.42
Typical High
$346.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$288.40
CareSource
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$354.81
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$380.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$134.90
Typical High
$213.80

Where Indiana sits

The same service costs 2.8 times more in Kansas than in Nebraska. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Indiana $141 · 41st of 51
KS $339NE $120

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.