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Pennsylvania rates for HCPCS L2768

Orthotic side bar disconnect device, per bar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.05 / $63.05 / $244.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.96 / $69.76 / $96.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.90 / $114.90 / $114.90
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
$116.66 / $153.19 / $153.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $99.06 / $153.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.31 / $72.31 / $134.15
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.94 / $153.19 / $291.08
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.51 / $84.51 / $708.06
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.45 / $107.24 / $109.18
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.05 / $63.05 / $244.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.96 / $73.78 / $244.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $218.40 / $301.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $99.06 / $153.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.31 / $72.31 / $181.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.54 / $145.82 / $145.82
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.54 / $145.82 / $149.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.30 / $77.67 / $127.39