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Montana rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.31 / $1,322.56 / $1,322.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.27 / $417.27 / $417.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $448.64 / $448.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.00 / $364.84 / $448.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.11 / $427.28 / $448.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.00 / $336.74 / $448.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.74 / $188.91 / $339.62