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Maryland rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.88 / $207.16 / $334.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.00 / $208.00 / $265.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.00 / $296.00 / $296.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $216.08 / $301.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.06 / $388.65 / $559.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.78 / $203.58 / $310.66
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.17 / $250.17 / $278.11