go back

New York rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.17 / $908.48 / $1,681.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.17 / $1,073.75 / $1,316.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,087.60 / $2,129.35 / $4,175.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.38 / $1,275.38 / $3,398.88
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,617.52 / $1,739.27 / $1,739.27
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,739.27 / $1,739.27 / $1,739.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,182.59 / $1,620.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $2,087.60 / $4,697.10
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.97 / $1,565.70 / $3,757.68
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.29 / $887.29 / $887.29
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.29 / $1,255.08 / $1,497.01
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $1,620.00 / $2,087.60
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,243.73 / $3,110.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.46 / $2,783.46 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.32 / $1,291.56 / $1,909.38
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,255.08 / $1,255.08 / $1,304.26
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.29 / $1,255.08 / $1,333.52