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Missouri rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.57 / $322.57 / $429.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.82 / $334.30 / $510.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.17 / $646.99 / $2,844.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.70 / $340.43 / $498.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $373.57 / $373.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $272.70 / $384.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.62 / $498.74 / $2,938.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.03 / $307.41 / $748.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.85 / $278.85 / $492.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.03 / $307.41 / $455.70