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Minnesota rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.29 / $513.29 / $513.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.17 / $500.88 / $513.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.83 / $738.73 / $1,028.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.98 / $701.79 / $738.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $2,279.11 / $6,330.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.50 / $907.89 / $1,087.76
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,353.08 / $2,186.69 / $4,984.29
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.50 / $856.50 / $881.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.70 / $738.73 / $3,084.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.18 / $315.04 / $741.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.18 / $307.12 / $741.82