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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Washington rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $380 · 10th–90th $282$8710%20%10th90th$380Professionalmedian $316 · 10th–90th $214$7410%10%20%10th90th$316$5.0$20.0$100.0$500.0$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
$245.47
Median
$245.47
Typical High
$588.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$245.47
Typical High
$1,288.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$389.05
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$371.54
Typical High
$380.19
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$295.12
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$562.34
Typical High
$1,071.52
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$467.74
Typical High
$870.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$288.40
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$371.54
Typical High
$416.87
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$426.58
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$549.54
Typical High
$758.58
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$371.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$380.19
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$512.86
Typical High
$616.60
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$371.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$275.42
Typical High
$331.13