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Pennsylvania rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,105.36 / $2,105.36 / $8,147.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.94 / $2,229.21 / $2,972.28
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
$3,589.85 / $4,714.47 / $4,714.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $4,714.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $4,128.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,337.32 / $4,714.47 / $8,957.51
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,183.45 / $3,183.45 / $3,300.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,105.36 / $2,105.36 / $8,147.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.94 / $2,229.21 / $3,831.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,845.40 / $6,722.20 / $9,288.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $4,714.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $5,599.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,370.65 / $4,487.31 / $4,487.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,370.65 / $4,487.31 / $4,597.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,890.35 / $5,753.36 / $6,904.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125.77 / $2,657.21 / $4,251.54