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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
$478.63 / $588.84 / $1,513.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,148.15 / $1,318.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $758.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,023.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $645.65 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $478.63 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $602.56 / $1,000.00