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Replacement Pretibial Shell

New Hampshire rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

Facilitymedian $575 · 10th–90th $316$6920%20%40%10th90th$575Professionalmedian $372 · 10th–90th $245$4900%20%10th90th$372$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$316.23
Typical High
$380.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$602.56
Typical High
$691.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$338.84
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
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$275.42
Typical High
$363.08
United
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$363.08
Typical High
$489.78
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$794.33