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Pennsylvania rates for HCPCS L2624

Addition To Lower Extremity Pelvic Control Hip Joint Adjustable Flexion Extension Abduction Control Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.53 / $153.53 / $594.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.69 / $169.87 / $252.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.07 / $373.06 / $373.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.02 / $291.02 / $399.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.45 / $212.45 / $349.79
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.51 / $399.47 / $758.99
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.91 / $251.91 / $279.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.53 / $153.53 / $594.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.69 / $179.66 / $284.07
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.60 / $544.79 / $787.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.02 / $291.02 / $399.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.45 / $212.45 / $544.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.72 / $355.09 / $355.09
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.72 / $355.09 / $447.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.40 / $184.46 / $215.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $187.98 / $336.43