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Breast Prosthesis, Mastectomy Form

Michigan rates for HCPCS L8020

Breast prosthesis, mastectomy form

Rates data updated July 2026.

How much does Breast Prosthesis, Mastectomy Form cost?

$158

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $331 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 8 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$158$145 to $275
FacilityA hospital or hospital-owned outpatient department$331$158 to $724

How much rates vary

Facilitymedian $331 · 10th to 90th $155 to $1,096Professionalmedian $158 · 10th to 90th $123 to $275
$1.0$10.0$100.0$1.0Kfacility $331professional $158

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
$154.88
Median
$154.88
Typical High
$154.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$147.91
Typical High
$158.49
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
BCBS
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$812.83
Typical High
$1,584.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$281.84
CareSource
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$295.12
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$512.86
Typical High
$575.44
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$218.78
Typical High
$331.13
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$229.09
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$194.98

Where Michigan 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.

Michigan $158 · 29th 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.