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New York rates for HCPCS L5681

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)

Facilitymedian $1,259 · 10th–90th $676$2,8840%10%20%10th90th$1,259Professionalmedian $955 · 10th–90th $676$2,1380%20%40%10th90th$955$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,258.93
Typical High
$1,778.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$1,258.93
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$3,162.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$977.24
Typical High
$2,511.89
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,288.25
Typical High
$1,288.25
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$53,703.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$1,862.09
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$2,630.27
Typical High
$6,025.60
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,584.89
Typical High
$3,019.95
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$776.25
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$933.25
Typical High
$1,000.00
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$3,019.95
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,513.56
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$1,071.52
Typical High
$4,365.16
United
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$1,023.29
Typical High
$2,630.27
Univera
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$933.25
Univera
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$933.25
Typical High
$1,000.00