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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
$218.78 / $478.63 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $537.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $1,230.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $1,023.29
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $501.19 / $501.19
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,047.13 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $602.56
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,000.00 / $2,344.23
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $676.08 / $1,174.90
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $398.11
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $380.19 / $380.19
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $588.84 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $457.09 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $501.19
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $371.54 / $398.11
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $380.19 / $380.19