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Virginia rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.97 / $281.44 / $281.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.97 / $281.44 / $329.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.22 / $569.22 / $604.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.43 / $340.43 / $438.81
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.00 / $305.00 / $389.12
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 / $373.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.45 / $512.29 / $683.06
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.02 / $333.15 / $647.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.00 / $711.53 / $948.13
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.86 / $430.85 / $712.75
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.86 / $430.85 / $712.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.03 / $276.36 / $364.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.19 / $283.97 / $427.77