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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

South Carolina rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $269 · 10th–90th $178$5130%20%10th90th$269Professionalmedian $209 · 10th–90th $170$3090%20%10th90th$209$200.0$500.0$1.0K$2.0K

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
$177.83
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$407.38
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$407.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$363.08
Typical High
$501.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$295.12
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$489.78
Medcost
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$234.42
Medcost
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$309.03
Typical High
$645.65
Medcost
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$281.84
Typical High
$512.86
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$199.53
Typical High
$316.23