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Replacement Pretibial Shell

Wisconsin rates for HCPCS L4130

Replace pretibial shell

Rates data updated July 2026.

Facilitymedian $589 · 10th–90th $437$1,2020%20%40%10th90th$589Professionalmedian $550 · 10th–90th $288$9770%20%10th90th$550$0.5$2.0$10.0$50.0$200.0$1.0K

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
$288.40
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$602.56
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$977.24
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,348.96
Typical High
$3,019.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$851.14
Typical High
$1,122.02
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$478.63
Typical High
$724.44
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$575.44
Typical High
$741.31
Medica
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$575.44
Typical High
$2,951.21
Medica
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$676.08
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$338.84
Network Health
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Network Health
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$660.69
Typical High
$1,148.15
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$478.63
Typical High
$724.44
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$575.44
Typical High
$741.31
Quartz
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$891.25
Typical High
$1,659.59
Quartz
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,202.26
Typical High
$3,019.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$870.96
Typical High
$3,801.89
United
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$323.59
Typical High
$588.84
United
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$288.40
Typical High
$562.34