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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

New Jersey rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $251 · 10th–90th $141$3980%20%10th90th$251Professionalmedian $204 · 10th–90th $148$3310%10%10th90th$204$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
Facility
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$181.97
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$295.12
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$380.19
Typical High
$512.86
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$354.81
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$239.88
Typical High
$389.05