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Vermont rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.60 / $246.38 / $284.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.47 / $408.47 / $408.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $371.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $315.55
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $296.00 / $371.07
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.08 / $296.00 / $315.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.80 / $379.42 / $419.79