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Replacement Pretibial Shell

Texas rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

Facilitymedian $490 · 10th–90th $288$1,3800%10%20%10th90th$490Professionalmedian $309 · 10th–90th $269$5010%50%10th90th$309$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$288.40
Median
$302.00
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$302.00
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$660.69
Typical High
$660.69
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
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,630.78
Median
$3,630.78
Typical High
$3,630.78
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$3,801.89
Median
$4,168.69
Typical High
$4,168.69
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$501.19
Typical High
$870.96
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$630.96
Typical High
$758.58
Molina
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$354.81
Providence
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$489.78
Typical High
$870.96
Providence
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$537.03
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$338.84
Typical High
$398.11
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$660.69
Typical High
$891.25