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Maine rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $338.84 / $851.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $660.69 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $371.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $588.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $275.42 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $346.74 / $575.44