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Texas rates for HCPCS L8031

Breast prosthesis, silicone or equal, with integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.29 / $175.29 / $189.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.29 / $189.31 / $350.58
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.37 / $400.37 / $400.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.45 / $277.45 / $277.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.54 / $202.54 / $277.45
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.56 / $1,976.32 / $2,177.31
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,200.21 / $2,200.21 / $2,911.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.64 / $320.30 / $421.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.33 / $360.33 / $400.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.44 / $289.23 / $400.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.54 / $202.54 / $315.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.43 / $232.88 / $307.32
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.17 / $258.69 / $400.37