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Nebraska rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.34 / $374.34 / $374.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.34 / $374.34 / $486.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.91 / $567.51 / $573.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $645.71 / $645.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.11 / $754.27 / $1,070.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.12 / $643.80 / $3,084.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.64 / $292.85 / $488.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.80 / $645.71 / $864.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.00 / $763.11 / $1,330.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.64 / $292.85 / $427.03