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Ohio rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.78 / $396.78 / $1,283.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.93 / $396.78 / $478.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.67 / $812.60 / $2,105.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.08 / $360.39 / $960.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.17 / $738.73 / $997.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.17 / $664.86 / $1,581.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $477.88 / $757.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $614.24
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.88 / $477.88 / $477.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $477.88 / $477.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.38 / $430.90 / $564.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.73 / $341.97 / $468.92