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New York rates for HCPCS L4130

Replace pretibial shell

Facilitymedian $407 · 10th–90th $191$1,0230%10%10th90th$407Professionalmedian $339 · 10th–90th $245$8510%20%10th90th$339$0.5$5.0$50.0$500.0$5.0K$50.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $446.68 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $309.03 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $954.99
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $467.74 / $467.74
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $676.08
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $933.25 / $2,187.76
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $575.44 / $1,096.48
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $199.53
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $338.84 / $354.81
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $549.54 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $323.59 / $1,584.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $371.54 / $954.99
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $323.59 / $338.84
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $338.84 / $354.81