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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

New York rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $282 · 10th–90th $170$5890%20%10th90th$282Professionalmedian $288 · 10th–90th $170$5890%20%10th90th$288$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$190.55
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$281.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$302.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$794.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$707.95
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$323.59
Typical High
$323.59
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$302.00
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$302.00
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$660.69
Typical High
$1,513.56
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$398.11
Typical High
$758.58
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$190.55
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$295.12
Typical High
$295.12
Fidelis
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$380.19
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$281.84
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$257.04
Typical High
$630.96
Univera
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$295.12
Univera
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$295.12
Typical High
$295.12