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New York rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.40 / $1,457.05 / $2,697.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.40 / $1,528.10 / $2,110.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,348.14 / $3,415.10 / $6,696.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.03 / $2,055.03 / $5,476.65
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,594.23 / $2,789.49 / $2,789.49
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,789.49 / $2,789.49 / $2,789.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $2,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $2,400.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $3,348.14 / $7,533.32
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.08 / $2,511.11 / $6,026.65
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,368.85 / $2,368.85 / $2,368.85
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.92 / $2,138.73 / $2,789.49
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,715.81 / $2,715.81 / $2,715.81
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $2,400.00 / $3,348.14
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,994.73 / $4,988.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.57 / $2,008.88 / $3,062.31
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,012.92 / $2,012.92 / $2,091.80
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.92 / $2,012.92 / $2,368.85