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Breast Prosthesis, Silicone or Equal, No Integral Adhesive

Wisconsin rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Rates data updated July 2026.

Facilitymedian $427 · 10th–90th $339$8320%50%10th90th$427Professionalmedian $398 · 10th–90th $214$7240%20%10th90th$398$0.5$2.0$10.0$50.0$200.0$1.0K

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
$213.80
Median
$346.74
Typical High
$831.76
Aetna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$354.81
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$707.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$478.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$1,000.00
Typical High
$2,187.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$616.60
Typical High
$812.83
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$346.74
Typical High
$537.03
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$478.63
Typical High
$575.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$426.58
Typical High
$1,995.26
Medica
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$281.84
Typical High
$467.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$213.80
Network Health
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$676.08
Network Health
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$489.78
Typical High
$851.14
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$346.74
Typical High
$537.03
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$426.58
Typical High
$457.09
Quartz
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$645.65
Typical High
$1,122.02
Quartz
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$870.96
Typical High
$1,995.26
Quartz
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$645.65
Typical High
$2,238.72
Security Health
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$389.05
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$281.84
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$218.78
Typical High
$389.05