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Missouri rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $1,318.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $588.84 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $758.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $891.25 / $5,128.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $549.54 / $6,165.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $870.96 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $524.81 / $776.25