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Pennsylvania rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,281.42 / $1,281.42 / $4,959.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.92 / $1,356.80 / $1,755.59
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
$2,184.94 / $2,869.45 / $2,869.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,743.07 / $3,041.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.44 / $1,272.44 / $3,818.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,798.55 / $3,041.90 / $5,779.61
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,937.61 / $1,937.61 / $1,937.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,281.42 / $1,281.42 / $4,959.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.92 / $1,356.80 / $2,136.37
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,060.40 / $4,148.80 / $5,993.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,743.07 / $3,041.90
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.44 / $1,272.44 / $3,818.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,371.18 / $1,371.18 / $2,731.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,371.18 / $2,731.19 / $2,895.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,342.11 / $1,642.24 / $2,587.69