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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

North Carolina rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $316 · 10th–90th $182$7080%20%10th90th$316Professionalmedian $295 · 10th–90th $178$3240%50%10th90th$295$0.5$5.0$50.0$500.0$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
$295.12
Median
$295.12
Typical High
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$302.00
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$588.84
Typical High
$794.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$295.12
Typical High
$309.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$331.13
Medcost
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$199.53
Typical High
$257.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$323.59
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$338.84
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$316.23
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,238.72
Median
$2,238.72
Typical High
$2,884.03