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Washington rates for HCPCS L4130

Replace pretibial shell

Facilitymedian $724 · 10th–90th $437–$1,4790%20%10th90th$724Professionalmedian $501 · 10th–90th $275–$9330%10%10th90th$501$1.0$5.0$20.0$100.0$500.0$2.0K

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
$501.19 / $501.19 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $338.84 / $645.65
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $724.44 / $724.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $371.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $831.76 / $2,089.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $812.83 / $1,288.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $575.44 / $630.96
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $724.44 / $741.31
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $645.65 / $741.31
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $1,096.48 / $1,479.11
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $724.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $758.58 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $302.00 / $537.03
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $537.03 / $1,148.15