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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Michigan rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $224$9120%20%40%10th90th$347Professionalmedian $240 · 10th–90th $191$4270%20%40%10th90th$240$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$223.87
Median
$245.47
Typical High
$602.56
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$229.09
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$323.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,258.93
Typical High
$2,454.71
BCBS
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$436.52
CareSource
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$295.12
Typical High
$467.74
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$758.58
Typical High
$891.25
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$338.84
Typical High
$512.86
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$354.81
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$346.74
Typical High
$512.86
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$302.00