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Virginia rates for HCPCS L4020

Replace quadrilateral socket brim, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.77 / $522.82 / $522.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.77 / $522.82 / $624.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.39 / $1,057.39 / $1,122.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.00 / $591.00 / $756.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.00 / $567.00 / $722.83
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 / $706.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.17 / $951.65 / $1,268.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.52 / $611.70 / $1,186.41
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.00 / $1,321.74 / $1,761.27
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.30 / $800.38 / $1,292.95
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.30 / $800.38 / $1,292.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.62 / $479.78 / $633.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.59 / $527.52 / $794.64