go back

Replacement Pretibial Shell

Pennsylvania rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

How much does Replacement Pretibial Shell cost?

$275

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $275 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $759 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$275$257 to $339
FacilityA hospital or hospital-owned outpatient department$759$234 to $912

How much rates vary

Facilitymedian $759 · 10th to 90th $234 to $1,862Professionalmedian $275 · 10th to 90th $234 to $501
$200$1K$5K$20Kfacility $759professional $275

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
$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

Where Pennsylvania 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.

Pennsylvania· 49th of 51

$275

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.