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Pennsylvania rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,882.25 / $1,882.25 / $7,284.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.62 / $1,992.97 / $2,754.41
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
$3,209.42 / $4,214.88 / $4,214.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,249.00 / $3,249.00 / $4,681.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.77 / $2,371.77 / $4,099.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,306.96 / $4,681.47 / $8,894.81
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,882.25 / $1,882.25 / $7,284.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.62 / $1,992.97 / $3,137.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,170.90 / $6,384.90 / $9,223.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,249.00 / $3,249.00 / $4,681.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.77 / $2,371.77 / $5,990.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,014.08 / $2,014.08 / $4,011.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,014.08 / $4,011.78 / $4,455.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,944.17 / $2,501.21 / $3,801.00