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Minnesota rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.26 / $401.26 / $401.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.66 / $401.26 / $467.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.70 / $577.50 / $804.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.00 / $548.63 / $577.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $1,781.50 / $4,947.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.38 / $709.54 / $850.11
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.65 / $1,709.26 / $3,896.03
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.38 / $669.38 / $688.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.42 / $577.50 / $2,938.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.90 / $288.11 / $677.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.45 / $276.36 / $278.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.90 / $288.11 / $601.28