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New Hampshire rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.72 / $314.72 / $377.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.26 / $244.22 / $314.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.94 / $558.94 / $662.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.43 / $340.43 / $356.69
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.55 / $452.55 / $1,396.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.88 / $290.18 / $325.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.90 / $278.85 / $331.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.63 / $460.49 / $586.08