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Pennsylvania rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.51 / $150.51 / $582.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.51 / $160.28 / $203.02
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
$256.62 / $337.02 / $337.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $409.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $358.64
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.81 / $409.58 / $778.20
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.58 / $227.58 / $227.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.51 / $150.51 / $582.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.56 / $165.25 / $273.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.39 / $558.60 / $806.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $409.58
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $396.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.06 / $233.06 / $320.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.06 / $320.77 / $389.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.27 / $202.21 / $294.47