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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Ohio rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $372 · 10th–90th $302$5250%20%40%10th90th$372Professionalmedian $224 · 10th–90th $191$4370%20%40%10th90th$224$0.5$2.0$10.0$50.0$200.0$1.0K

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
$302.00
Median
$346.74
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$346.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$323.59
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$457.09
Typical High
$912.01
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$275.42
Typical High
$562.34
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
CareSource
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$338.84
Typical High
$478.63
CareSource
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$354.81
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$331.13
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$302.00
Typical High
$346.74
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$257.04
Molina
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$269.15
Typical High
$380.19
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$478.63
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$346.74
Typical High
$436.52
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$338.84