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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Pennsylvania rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $513 · 10th–90th $174$1,9050%20%10th90th$513Professionalmedian $204 · 10th–90th $158$3890%20%10th90th$204$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
$173.78
Median
$173.78
Typical High
$676.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$190.55
Typical High
$338.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$323.59
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$288.40
Typical High
$288.40
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$295.12
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$512.86
Typical High
$758.58
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$275.42
Typical High
$398.11
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$288.40
Typical High
$288.40
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$676.08
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$190.55
Typical High
$331.13
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,380.38
Typical High
$2,238.72
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$371.54
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$512.86
Typical High
$512.86
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$398.11