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New York rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.88 / $260.39 / $481.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.88 / $286.83 / $377.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.34 / $610.30 / $1,196.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.40 / $352.40 / $948.78
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$463.61 / $498.51 / $498.51
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.51 / $498.51 / $498.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $598.34 / $1,346.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.95 / $448.76 / $1,077.01
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.75 / $378.75 / $378.75
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.73 / $378.75 / $454.50
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $598.34
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.48 / $364.87 / $904.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.00 / $359.00 / $547.26
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.73 / $359.73 / $373.82
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.73 / $359.73 / $382.21