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Utah rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.52 / $312.52 / $312.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.52 / $441.83 / $3,732.96
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 / $1,361.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.20 / $708.39 / $920.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.68 / $947.62 / $947.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.61 / $679.25 / $1,018.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.42 / $484.10 / $633.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.05 / $484.10 / $568.57