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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Indiana rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $427 · 10th–90th $200$5370%20%40%10th90th$427Professionalmedian $209 · 10th–90th $178$3630%20%40%10th90th$209$0.5$2.0$10.0$50.0$200.0$1.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$416.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$323.59
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$426.58
Typical High
$537.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$446.68
CareSource
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$512.86
Typical High
$588.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$302.00
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$302.00
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$338.84