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Utah rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.51 / $1,272.51 / $1,272.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.51 / $1,398.57 / $12,455.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.59 / $3,060.59 / $3,060.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $2,234.23 / $5,178.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $3,264.13 / $4,243.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,915.19 / $4,366.46 / $4,366.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,486.41 / $3,129.88 / $4,694.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,779.73 / $1,971.11 / $2,820.73