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New York rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,344.23 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,630.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $6,025.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $5,128.61
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,454.71 / $2,454.71
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $5,248.07 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,951.21
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $4,897.79 / $11,481.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $3,311.31 / $5,754.40
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,621.81
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $1,862.09
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,884.03 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $2,344.23 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,621.81 / $2,454.71
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $1,819.70
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $1,862.09