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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Montana rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $417 · 10th–90th $282$5250%20%10th90th$417Professionalmedian $417 · 10th–90th $148$5250%20%10th90th$417$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Global
Typical Low
$123.03
Median
$331.13
Typical High
$1,995.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$446.68
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$446.68
Typical High
$446.68
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$416.87
Typical High
$812.83
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$416.87
Typical High
$812.83
Providence
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$398.11
Typical High
$562.34
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$338.84
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$239.88
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$190.55
Typical High
$302.00