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Massachusetts rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.22 / $244.22 / $244.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.22 / $271.66 / $387.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.27 / $941.10 / $3,539.94
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.08 / $425.60 / $545.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.31 / $323.31 / $960.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.31 / $373.57 / $391.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $669.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.55 / $452.55 / $475.18
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.75 / $417.75 / $417.75
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.33 / $3,539.94 / $3,539.94
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.85 / $289.25 / $545.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $276.36 / $364.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.34 / $298.77 / $545.84