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North Carolina rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.06 / $498.06 / $859.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.84 / $498.06 / $498.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.17 / $843.73 / $1,039.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.22 / $426.60 / $426.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.84 / $477.88 / $477.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.47 / $348.85 / $856.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.20 / $498.06 / $673.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.00 / $320.00 / $386.75
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.40 / $907.40 / $1,399.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.02 / $283.76 / $430.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.58 / $3,602.35 / $3,602.35
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,797.19 / $3,797.19 / $5,687.93