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Maine rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.62 / $345.25 / $345.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.89 / $655.43 / $1,214.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.43 / $362.98 / $362.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.75 / $477.88 / $477.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $477.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.52 / $460.52 / $460.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.27 / $345.25 / $345.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.64 / $306.10 / $652.57