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Minnesota rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.43 / $353.43 / $353.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.60 / $310.87 / $353.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.46 / $421.95 / $587.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.56 / $400.85 / $421.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,301.46 / $3,614.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.00 / $518.34 / $621.03
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.66 / $1,248.69 / $2,846.23
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.00 / $489.00 / $503.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.61 / $421.95 / $1,976.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.43 / $251.88 / $445.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $201.72 / $423.72