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New Hampshire rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.27 / $284.27 / $341.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.93 / $220.59 / $284.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.87 / $504.87 / $598.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.11 / $278.11 / $284.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $301.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $216.08 / $315.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.77 / $408.77 / $1,261.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.80 / $251.87 / $424.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.27 / $357.97 / $539.09