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Massachusetts rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.26 / $428.26 / $428.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.26 / $476.40 / $685.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.13 / $1,297.21 / $6,145.65
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.13 / $743.88 / $957.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.35 / $1,265.71 / $1,630.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.96 / $720.41 / $751.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $548.95 / $1,347.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.61 / $793.61 / $833.29
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.34 / $656.34 / $656.34
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,359.85 / $6,145.65 / $6,145.65
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.18 / $522.19 / $957.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $479.78 / $633.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.42 / $523.94 / $957.21