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Maine rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.02 / $340.02 / $340.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.31 / $340.03 / $340.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.03 / $581.76 / $1,078.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.11 / $284.27 / $379.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $371.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $216.08 / $296.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.77 / $408.77 / $408.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.95 / $340.02 / $340.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.92 / $284.62 / $579.23