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Pennsylvania rates for HCPCS L5940

Addition, endoskeletal system, below knee (BK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.86 / $268.86 / $1,040.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.77 / $284.68 / $448.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.65 / $451.54 / $451.54
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
$458.43 / $602.04 / $602.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $654.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.88 / $278.88 / $572.70
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.72 / $654.04 / $1,242.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.44 / $470.36 / $481.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.86 / $268.86 / $1,040.49
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.94 / $295.22 / $510.97
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,970.00 / $18,970.00 / $18,970.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.90 / $892.00 / $1,288.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $654.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.88 / $278.88 / $697.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.33 / $416.33 / $573.04
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.33 / $573.04 / $622.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.58 / $339.34 / $542.94