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New York rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,735.50 / $4,423.59 / $8,188.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,735.50 / $4,526.18 / $6,408.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,164.96 / $10,368.27 / $20,329.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,635.06 / $5,635.06 / $15,778.16
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,876.08 / $8,468.90 / $8,468.90
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,468.90 / $8,468.90 / $8,468.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $4,856.05 / $6,652.12
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $10,164.96 / $22,871.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,997.33 / $7,665.75 / $18,520.58
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,111.24 / $6,493.20 / $8,468.90
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $6,652.12 / $10,164.96
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,282.46 / $14,901.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,380.80 / $6,098.98 / $9,297.20
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,433.58 / $6,111.24 / $6,111.24
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,111.24 / $6,111.24 / $6,493.20