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South Carolina rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.06 / $177.06 / $177.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.60 / $177.06 / $294.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.17 / $267.17 / $395.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.27 / $218.27 / $218.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $307.68 / $444.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.29 / $296.00 / $326.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $267.08 / $301.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.13 / $284.00 / $621.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.00 / $223.00 / $252.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.45 / $267.45 / $267.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.69 / $195.70 / $300.58