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Maine rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.32 / $339.27 / $339.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.12 / $644.07 / $1,193.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.43 / $356.69 / $356.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $373.57 / $410.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $277.82 / $373.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.55 / $452.55 / $452.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.72 / $339.27 / $339.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.61 / $276.36 / $276.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.90 / $300.79 / $641.26