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Pennsylvania rates for HCPCS L4130

Replace pretibial shell

Facilitymedian $646 · 10th–90th $234$9120%20%10th90th$646Professionalmedian $295 · 10th–90th $234$5130%20%40%10th90th$295$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
$234.42 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $295.12 / $501.19
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $467.74 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $371.54
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $741.31 / $1,071.52
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $398.11 / $575.44
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $295.12 / $398.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $794.33 / $1,096.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $537.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $398.11 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $758.58 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $281.84 / $575.44