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Breast Prosthesis, Mastectomy Form

Utah rates for HCPCS L8020

Breast prosthesis, mastectomy form

Rates data updated July 2026.

How much does Breast Prosthesis, Mastectomy Form cost?

$145

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $126 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 7 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$145$110 to $245
FacilityA hospital or hospital-owned outpatient department$126$77.62 to $240

How much rates vary

Facilitymedian $126 · 10th to 90th $78 to $240Professionalmedian $145 · 10th to 90th $78 to $1,096
$50.0$100.0$200.0$500.0$1.0Kfacility $126professional $145

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
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$1,096.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$169.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$173.78
Typical High
$229.09
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$239.88
Typical High
$239.88
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$323.59
Select Health
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$239.88
Typical High
$295.12
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$134.90
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$186.21

Where Utah 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.

Utah $145 · 39th 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.