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Pennsylvania rates for HCPCS L5679

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism

Facilitymedian $912 · 10th–90th $316–$1,2020%20%10th90th$912Professionalmedian $372 · 10th–90th $295–$7080%20%40%10th90th$372$1.0$10.0$100.0$1.0K$10.0K

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
$316.23 / $1,202.26 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $371.54 / $645.65
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
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
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $436.52
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $891.25 / $1,288.25
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $478.63 / $724.44
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $524.81 / $562.34
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $371.54 / $562.34
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $1,047.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $676.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $501.19 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $912.01 / $1,047.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $676.08