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New York rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,732.50 / $2,051.64 / $3,797.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,732.50 / $2,079.85 / $2,972.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,714.47 / $4,808.77 / $9,428.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,902.12 / $2,902.12 / $7,734.14
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,652.89 / $3,927.84 / $3,927.84
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,927.84 / $3,927.84 / $3,927.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $2,886.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $2,886.72
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $4,714.47 / $10,607.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,781.54 / $3,535.86 / $8,486.06
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,726.78 / $3,726.78 / $3,726.78
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,834.36 / $3,011.51 / $3,927.84
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,824.06 / $3,824.06 / $3,824.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $2,886.72 / $4,714.47
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $6,999.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,753.36 / $5,753.36 / $5,753.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.00 / $2,828.69 / $4,243.03
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,834.36 / $2,834.36 / $3,150.08
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,834.36 / $2,834.36 / $3,726.78