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California rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $741.31 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $1,737.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $316.23 / $371.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $269.15 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $295.12 / $524.81
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $794.33 / $1,071.52
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $870.96 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $295.12 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $295.12
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $309.03 / $562.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $467.74 / $758.58
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $407.38 / $575.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $371.54
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $371.54 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $251.19 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $467.74