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Pennsylvania rates for HCPCS L5658

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

Facilitymedian $589 · 10th–90th $204–$7940%20%10th90th$589Professionalmedian $245 · 10th–90th $186–$3980%20%10th90th$245$0.5$5.0$50.0$500.0$5.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $794.33 / $794.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $245.47 / $380.19
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $380.19 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $363.08
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $630.96 / $912.01
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $331.13 / $467.74
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $245.47 / $380.19
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $645.65 / $933.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $436.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $524.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $588.84 / $676.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $263.03 / $478.63