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Utah rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.95 / $121.95 / $121.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.95 / $175.29 / $1,322.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.33 / $296.00 / $301.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $315.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.39 / $311.93 / $405.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.15 / $417.27 / $417.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.61 / $299.10 / $448.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.57 / $188.91 / $270.33