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Nebraska rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.67 / $695.67 / $695.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.67 / $695.67 / $903.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.77 / $1,054.66 / $1,065.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.98 / $1,199.97 / $1,199.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.27 / $1,347.75 / $1,850.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.40 / $1,194.06 / $5,145.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.00 / $544.23 / $907.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.45 / $1,199.97 / $1,511.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.00 / $1,418.14 / $2,472.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.54 / $479.78 / $745.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.56 / $544.23 / $745.99