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Arkansas rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.53 / $222.53 / $222.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.60 / $222.53 / $222.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.30 / $320.30 / $320.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.64 / $457.46 / $508.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.65 / $388.65 / $395.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.65 / $388.65 / $388.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $320.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $312.79
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.35 / $368.35 / $368.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $199.74 / $307.75