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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Washington, DC rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $209 · 10th–90th $209$6170%50%90th$209Professionalmedian $209 · 10th–90th $182$2450%20%40%10th90th$209$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$208.93
Typical High
$245.47
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$316.23
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$398.11
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$204.17
Typical High
$302.00