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California rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.79 / $582.79 / $3,732.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.30 / $582.79 / $3,732.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.57 / $1,823.25 / $4,106.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.09 / $591.00 / $1,081.11
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,531.76 / $2,735.29
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,716.68 / $3,998.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.14 / $751.98 / $751.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $548.95 / $1,347.75
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.05 / $585.66 / $1,423.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.29 / $905.67 / $1,966.61
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,359.85 / $6,145.65 / $6,145.65
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,210.34 / $6,210.34 / $9,281.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,325.76 / $2,325.76 / $2,325.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.52 / $1,116.33 / $1,293.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $548.95 / $1,106.47
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,442.02 / $2,442.02 / $2,442.02
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.05 / $829.69 / $1,035.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.95 / $439.56 / $479.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.56 / $484.89 / $1,251.89