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Oklahoma rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.78 / $171.78 / $171.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.78 / $195.90 / $196.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.27 / $300.27 / $300.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.83 / $350.58 / $350.58
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 / $296.00 / $301.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.95 / $240.47 / $1,976.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $228.65 / $395.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.94 / $190.83 / $284.56