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Hawaii rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.60 / $236.60 / $236.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.65 / $395.65 / $395.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.00 / $296.00 / $547.86
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.05 / $521.52 / $521.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.64 / $498.05 / $697.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.08 / $395.65 / $547.86
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.81 / $401.20 / $474.05