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New York rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $155 · 10th–90th $65$3090%10%20%10th90th$155Professionalmedian $95 · 10th–90th $65$2240%20%10th90th$95$0.1$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $177.83 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $75.86 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $120.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $263.03
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $125.89 / $125.89
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $177.83
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $251.19 / $588.84
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $154.88 / $295.12
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $102.33
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $95.50 / $95.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $147.91
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $104.71 / $426.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $100.00 / $257.04
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $91.20 / $102.33
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $95.50 / $95.50