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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Utah rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $219 · 10th–90th $123$4270%20%40%10th90th$219Professionalmedian $240 · 10th–90th $123$1,9950%10%10th90th$240$50.0$100.0$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
$123.03
Median
$123.03
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$229.09
Typical High
$1,995.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$309.03
Typical High
$407.38
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$426.58
Typical High
$426.58
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$302.00
Typical High
$426.58
Select Health
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$436.52
Select Health
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$416.87
Typical High
$436.52
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$436.52
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$229.09
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$323.59