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Alaska rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.84 / $407.84 / $407.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $296.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $315.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.95 / $121.95 / $121.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.72 / $442.46 / $698.63
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.42 / $245.42 / $245.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.95 / $121.95 / $296.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $406.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.11 / $232.36 / $445.35