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Maine rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.51 / $594.95 / $594.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.77 / $1,129.46 / $2,093.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.00 / $619.23 / $619.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.16 / $751.98 / $751.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.95 / $548.95 / $751.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.61 / $793.61 / $793.61
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.90 / $594.95 / $594.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.35 / $479.78 / $479.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.00 / $489.00 / $1,124.55