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Pennsylvania rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $213.80 / $489.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $295.12 / $323.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $295.12 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $302.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $512.86 / $758.58
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $275.42 / $398.11
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $269.15 / $288.40
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $676.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $213.80 / $467.74
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $630.96 / $2,187.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $524.81 / $758.58
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $275.42 / $371.54
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $371.54 / $407.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $512.86 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $213.80 / $354.81