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Pennsylvania rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $158 · 10th–90th $68$2630%20%10th90th$158Professionalmedian $76 · 10th–90th $65$1510%20%40%10th90th$76$0.1$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
$67.61 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $131.83
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
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $100.00
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $199.53 / $295.12
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $107.15 / $154.88
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $117.49 / $123.03
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $75.86 / $114.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $234.42
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $107.15 / $199.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $144.54 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $186.21 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $154.88