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Wisconsin rates for HCPCS L8030

Breast prosthesis, silicone or equal, without integral adhesive

Facilitymedian $427 · 10th–90th $347–$7760%50%10th90th$427Professionalmedian $331 · 10th–90th $191–$6460%20%10th90th$331$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $489.78 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $354.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $1,000.00 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $616.60 / $812.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $346.74 / $537.03
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $478.63 / $575.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $426.58 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $281.84 / $467.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $213.80
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $489.78 / $851.14
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $645.65 / $1,202.26
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $851.14 / $2,187.76
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $436.52 / $2,187.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $281.84 / $426.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $354.81