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New York rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $3,162.28 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,584.89 / $2,754.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,398.83 / $2,630.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $5,623.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,041.74 / $4,786.30
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,290.87 / $2,290.87
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $5,011.87 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $2,754.23
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,677.35 / $10,715.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,019.95 / $5,370.32
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,041.74
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $1,949.84
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,238.72
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,691.53 / $2,691.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $3,162.28 / $3,715.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,479.11 / $2,290.87
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,862.09 / $2,041.74
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,778.28 / $1,949.84