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Pennsylvania rates for HCPCS L5301

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.67 / $1,230.67 / $4,762.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.44 / $1,303.06 / $1,991.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.31 / $2,066.84 / $2,066.84
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
$2,098.40 / $2,755.79 / $2,755.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $2,755.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $2,413.07
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,535.33 / $2,755.79 / $5,236.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,152.96 / $2,204.64 / $2,204.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.67 / $1,230.67 / $4,762.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.44 / $1,351.32 / $2,239.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,416.80 / $3,929.40 / $5,429.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $2,755.79
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $3,749.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.08 / $1,786.08 / $2,623.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.08 / $2,623.00 / $2,675.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,123.22 / $3,674.38 / $4,409.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.54 / $1,614.72 / $2,428.42