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Massachusetts rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.59 / $220.59 / $220.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.65 / $220.59 / $324.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.50 / $981.78 / $2,177.31
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.22 / $339.62 / $493.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$535.87 / $651.95 / $839.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.52 / $439.83 / $439.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.02 / $296.00 / $353.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $489.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.77 / $408.77 / $429.21
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.60 / $376.60 / $383.36
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.60 / $383.36 / $383.36
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.56 / $2,177.31 / $2,177.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.91 / $269.87 / $493.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.22 / $269.87 / $408.77