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Nebraska rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.95 / $392.95 / $392.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.95 / $392.95 / $510.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.57 / $595.72 / $601.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $677.80 / $677.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.57 / $677.80 / $1,045.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.70 / $674.46 / $2,938.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.85 / $307.41 / $512.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.81 / $677.80 / $854.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.59 / $802.46 / $1,396.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.55 / $276.36 / $429.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.87 / $307.41 / $427.29