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New Hampshire rates for HCPCS L4020

Replace Quadrilateral Socket Brim, Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.90 / $551.90 / $662.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.26 / $517.53 / $551.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$980.18 / $980.18 / $1,161.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.00 / $591.00 / $619.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.98 / $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 / $2,449.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.39 / $503.77 / $564.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.00 / $489.00 / $580.62
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.12 / $807.53 / $1,027.77