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Utah rates for HCPCS L4030

Replace Quadrilateral Socket Brim, Custom Fitted

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.20 / $183.20 / $183.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.20 / $258.99 / $2,188.15
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 / $865.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.44 / $415.24 / $539.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.06 / $555.47 / $555.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.30 / $398.16 / $597.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.19 / $281.23 / $341.28