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Illinois rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.82 / $296.82 / $296.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.50 / $296.82 / $462.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.06 / $1,167.46 / $4,968.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.49 / $438.90 / $438.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $373.57 / $677.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $669.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.88 / $645.21 / $794.20
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.75 / $750.75 / $750.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.68 / $435.27 / $457.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.83 / $276.36 / $577.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.38 / $288.11 / $494.59