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Alaska rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.75 / $1,125.75 / $1,125.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.98 / $751.98 / $751.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $548.95 / $548.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.52 / $312.52 / $312.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.57 / $1,248.44 / $1,971.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.52 / $312.52 / $751.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $800.65 / $1,265.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.78 / $633.41 / $633.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.15 / $1,256.58 / $1,639.04