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Iowa rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.82 / $513.29 / $513.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.09 / $368.76 / $513.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $477.88 / $645.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.71 / $856.50 / $1,070.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.66 / $738.73 / $866.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.76 / $754.27 / $3,084.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.63 / $320.60 / $802.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.80 / $645.71 / $864.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.84 / $754.27 / $1,233.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.63 / $292.85 / $753.06
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.66 / $557.66 / $557.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.55 / $557.66 / $557.66