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Pennsylvania rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.37 / $426.37 / $1,650.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.09 / $451.45 / $710.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.04 / $716.06 / $716.06
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
$726.99 / $954.75 / $954.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $999.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,107.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.40 / $999.35 / $1,898.77
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.06 / $763.80 / $763.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.37 / $426.37 / $1,650.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.08 / $451.45 / $780.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.80 / $1,363.00 / $1,968.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $999.35
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,107.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.22 / $660.22 / $908.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.22 / $908.74 / $951.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.99 / $629.41 / $717.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.49 / $572.85 / $860.99