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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Texas rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $316 · 10th–90th $174$8510%10%20%10th90th$316Professionalmedian $214 · 10th–90th $170$3470%20%40%10th90th$214$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$190.55
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$213.80
Typical High
$346.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$239.88
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$309.03
Typical High
$407.38
Christus
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$295.12
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,238.72
Typical High
$2,238.72
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,238.72
Median
$2,884.03
Typical High
$2,884.03
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$316.23
Typical High
$524.81
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$363.08
Typical High
$407.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$239.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$302.00
Typical High
$537.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$323.59
Typical High
$436.52
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$234.42
Typical High
$302.00
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$407.38
Typical High
$549.54