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Pennsylvania rates for HCPCS L4210

Repair of orthotic device, repair or replace minor parts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.16 / $18.16 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $22.00
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
$38.54 / $40.00 / $46.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $117.89 / $117.89
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $59.50 / $90.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.16 / $18.16 / $77.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $26.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $117.89 / $117.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.77 / $28.77 / $28.77