go back

Michigan rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.97 / $439.68 / $1,075.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.81 / $240.97 / $245.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.45 / $316.45 / $316.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.65 / $1,272.43 / $2,317.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.85 / $421.95 / $569.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.62 / $257.27 / $274.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.56 / $337.56 / $337.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $301.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.00 / $296.00 / $489.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.30 / $439.68 / $1,075.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.58 / $304.92 / $431.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.03 / $312.24 / $359.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.43 / $201.72 / $316.77