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Replacement Pretibial Shell

Pennsylvania rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

Facilitymedian $759 · 10th–90th $234$1,8620%20%10th90th$759Professionalmedian $275 · 10th–90th $234$5010%20%40%10th90th$275$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
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$275.42
Typical High
$501.19
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$467.74
Typical High
$575.44
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
$371.54
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$741.31
Typical High
$1,071.52
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$398.11
Typical High
$575.44
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$912.01
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$275.42
Typical High
$512.86
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,380.38
Typical High
$2,187.76
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$758.58
Typical High
$758.58
United
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$281.84
Typical High
$575.44