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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Virginia rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $389 · 10th–90th $195$4900%20%10th90th$389Professionalmedian $214 · 10th–90th $174$4070%20%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
$190.55
Median
$204.17
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$239.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$575.44
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$257.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$398.11
Typical High
$549.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$257.04
Typical High
$389.05
Medcost
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$478.63
Medcost
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$213.80
Typical High
$257.04
Sentara
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$323.59
Typical High
$1,148.15
Sentara
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$323.59
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$194.98
Typical High
$323.59