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Missouri rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.30 / $307.30 / $409.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.30 / $318.47 / $486.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.01 / $616.36 / $2,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.45 / $346.43 / $474.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $477.88 / $477.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $405.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.30 / $475.13 / $3,084.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.10 / $292.85 / $713.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.49 / $292.85 / $548.40