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Pennsylvania rates for HCPCS L5649

Addition To Lower Extremity Ischial Containment/Narrow M-L Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.32 / $1,071.32 / $4,146.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.28 / $1,134.33 / $1,544.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,039.12 / $2,039.12 / $2,039.12
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
$1,826.70 / $2,398.96 / $2,398.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $2,285.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $2,110.78
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,102.37 / $2,285.19 / $4,341.85
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.28 / $1,679.28 / $1,769.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.32 / $1,071.32 / $4,146.01
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.27 / $1,176.33 / $1,919.18
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.80 / $3,116.70 / $4,502.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $2,285.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $3,430.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.34 / $1,146.34 / $2,283.37
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,146.34 / $2,283.37 / $2,329.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,104.48 / $1,296.56 / $2,096.03