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Pennsylvania rates for HCPCS L5700

Replacement Socket Below Knee Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.16 / $1,544.16 / $5,975.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.26 / $1,635.00 / $2,549.44
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
$2,632.95 / $3,457.80 / $3,457.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $3,348.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $2,931.75
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,080.29 / $3,348.14 / $6,361.47
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.46 / $2,701.41 / $2,766.24
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,544.16 / $1,544.16 / $5,975.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.25 / $1,695.54 / $2,733.48
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,267.69 / $4,358.89 / $6,596.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $3,348.14
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $4,293.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,391.11 / $2,391.11 / $3,291.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,391.11 / $3,291.19 / $3,357.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.14 / $1,926.32 / $3,041.97