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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
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $537.03 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $776.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $707.95 / $912.01
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $851.14 / $1,479.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,047.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $977.24 / $1,096.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $478.63 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $478.63 / $691.83