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Pennsylvania rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.01 / $102.01 / $394.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.09 / $102.01 / $121.75
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
$173.93 / $228.41 / $228.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $227.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $199.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.45 / $227.66 / $432.55
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.24 / $154.24 / $159.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.01 / $102.01 / $394.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.09 / $108.01 / $185.66
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $310.50 / $448.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $227.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $226.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.16 / $109.16 / $217.41
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.16 / $216.69 / $217.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.00 / $129.59 / $199.57