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Replacement Pretibial Shell

Maine rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

How much does Replacement Pretibial Shell cost?

$355

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $355 for this service. The price depends on where it is billed: about $339 from a physician practice, and about $589 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$339$316 to $490
FacilityA hospital or hospital-owned outpatient department$589$372 to $661

How much rates vary

Facilitymedian $589 · 10th to 90th $347 to $708Professionalmedian $339 · 10th to 90th $257 to $490
$200$500$1Kfacility $589professional $339

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$338.84
Typical High
$354.81
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$660.69
Typical High
$758.58
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$446.68
Cigna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$407.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$371.54
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$588.84
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$338.84
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$275.42
Typical High
$371.54
United
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$478.63
Typical High
$489.78

Where Maine sits

The same service costs 3.5 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maine· 21st of 51

$355

HI $813DC $234

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.