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New York rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.65 / $168.93 / $312.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.65 / $173.56 / $245.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.19 / $395.95 / $776.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.11 / $278.11 / $667.76
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.77 / $323.42 / $323.42
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.42 / $323.42 / $323.42
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 / $301.92
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $388.19 / $873.43
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.03 / $295.58 / $698.74
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.44 / $182.44 / $182.44
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.44 / $298.42 / $298.42
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.91 / $206.91 / $206.91
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.91 / $314.88 / $314.88
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $301.92 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.31 / $216.08 / $542.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.11 / $249.63 / $351.29
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.38 / $298.42 / $298.42
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.44 / $298.42 / $298.42