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Minnesota rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $588.84 / $912.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,174.90 / $1,698.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $4,365.16 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,548.82 / $1,698.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $4,365.16 / $8,128.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,819.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $1,174.90 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $478.63 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $478.63 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $537.03 / $1,445.44