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Tennessee rates for HCPCS L4030

Replace quadrilateral socket brim, custom fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.90 / $255.90 / $279.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.16 / $279.60 / $478.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.90 / $511.92 / $511.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.04 / $477.88 / $477.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.85 / $348.85 / $455.04
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.58 / $3,084.21 / $3,602.35
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,708.18 / $3,797.19 / $5,687.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.18 / $281.23 / $407.10