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Ohio rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.03 / $320.97 / $694.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.27 / $206.03 / $328.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.40 / $316.45 / $316.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.21 / $464.15 / $1,202.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.84 / $247.00 / $548.53
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.66 / $358.66 / $358.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.85 / $421.95 / $569.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.27 / $379.76 / $903.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $485.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $216.08 / $350.85
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $301.92
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $296.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.24 / $256.08 / $335.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.34 / $210.51 / $339.62