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Pennsylvania rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Facilitymedian $224 · 10th–90th $98$3800%20%10th90th$224Professionalmedian $115 · 10th–90th $93$2190%20%10th90th$115$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$97.72 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $114.82 / $181.97
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
$218.78 / $218.78 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $141.25
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $288.40 / $426.58
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $223.87
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $154.88 / $223.87
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $112.20 / $181.97
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $295.12 / $426.58
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $186.21 / $208.93
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $295.12 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $223.87