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New York rates for HCPCS L5703

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.97 / $1,214.96 / $2,248.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.97 / $1,239.83 / $1,760.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,791.85 / $2,847.69 / $5,583.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.81 / $1,526.81 / $4,303.14
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,163.19 / $2,326.02 / $2,326.02
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,326.02 / $2,326.02 / $2,326.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,119.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,547.24 / $2,119.51
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $2,791.85 / $6,281.66
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,614.54 / $2,093.89 / $5,025.33
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,018.17 / $2,018.17 / $2,018.17
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,678.48 / $1,783.38 / $2,326.02
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,264.57 / $2,264.57 / $2,264.57
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $2,119.51 / $2,791.85
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,725.50 / $4,159.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.55 / $1,585.63 / $2,406.37
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,492.36 / $1,678.48 / $1,678.48
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,678.48 / $1,678.48 / $2,018.17