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Replacement Pretibial Shell

New York rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

How much does Replacement Pretibial Shell cost?

$339

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $339 for this service. The price depends on where it is billed: about $339 from a physician practice, and about $355 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 9 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$288 to $490
FacilityA hospital or hospital-owned outpatient department$355$245 to $575

How much rates vary

Facilitymedian $355 · 10th to 90th $191 to $912Professionalmedian $339 · 10th to 90th $245 to $832
$1.0$10.0$100.0$1.0K$10.0Kfacility $355professional $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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$275.42
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$309.03
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$1,148.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$954.99
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$467.74
Typical High
$467.74
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$398.11
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$933.25
Typical High
$2,187.76
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$602.56
Typical High
$1,096.48
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$354.81
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$549.54
Typical High
$645.65
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$323.59
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$371.54
Typical High
$912.01
Univera
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$323.59
Typical High
$338.84
Univera
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$354.81

Where New York sits

The same service costs 3.5 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

New York $339 · 29th of 51
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.