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Pennsylvania rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.32 / $56.32 / $217.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.32 / $61.84 / $88.76
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
$96.03 / $126.12 / $126.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $157.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $166.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.62 / $157.19 / $298.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.28 / $88.28 / $88.28
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.32 / $56.32 / $217.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.22 / $61.84 / $102.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.40 / $214.40 / $309.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $157.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $166.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.24 / $60.24 / $120.04
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.24 / $120.04 / $149.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.13 / $82.54 / $94.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.98 / $75.67 / $113.70