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New York rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,867.40 / $2,211.38 / $4,093.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,867.40 / $2,231.36 / $3,203.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,081.54 / $5,183.17 / $10,163.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.31 / $2,547.31 / $7,757.47
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,937.30 / $4,233.66 / $4,233.66
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,233.66 / $4,233.66 / $4,233.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $3,006.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,194.96 / $2,194.96 / $3,006.81
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $5,081.54 / $11,433.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,623.95 / $3,779.14 / $9,146.77
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,878.50 / $2,878.50 / $2,878.50
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,878.50 / $3,055.05 / $3,643.95
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $3,006.81 / $5,081.54
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,194.96 / $3,006.81 / $6,735.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.08 / $2,886.04 / $4,575.22
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,055.05 / $3,055.05 / $3,174.76
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,878.50 / $3,055.05 / $3,245.99