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Breast Prosthesis, Silicone or Equal, with Integral Adhesive

Washington rates for HCPCS L8031

Breast prosthesis, silicone or equal, with integral adhesive

Rates data updated July 2026.

Facilitymedian $417 · 10th–90th $316$9770%20%10th90th$417Professionalmedian $316 · 10th–90th $204$7590%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
$1,995.26
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
$275.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$275.42
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$660.69
Typical High
$1,148.15
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$602.56
Typical High
$933.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$380.19
Typical High
$389.05
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$380.19
Typical High
$426.58
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$575.44
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
$616.60
Typical High
$616.60
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$281.84
Typical High
$371.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$269.15
Typical High
$575.44