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Indiana rates for HCPCS L4030

Replace Quadrilateral Socket Brim, Custom Fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.63 / $365.63 / $738.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.18 / $365.63 / $396.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.60 / $661.16 / $738.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.08 / $346.43 / $478.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.48 / $775.67 / $1,034.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.91 / $812.60 / $997.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $477.88 / $738.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $757.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.18 / $340.76 / $476.06