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Pennsylvania rates for HCPCS L5856

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,631.57 / $12,631.57 / $48,884.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,119.32 / $13,374.61 / $17,913.63
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,538.07 / $28,285.52 / $28,285.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $28,413.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $11,826.18 / $24,880.04
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,140.61 / $28,413.71 / $53,986.05
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,099.81 / $21,214.14 / $21,214.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,631.57 / $12,631.57 / $48,884.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,119.31 / $13,374.61 / $22,989.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,383.50 / $38,752.50 / $55,980.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $28,413.71
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $11,826.18 / $33,597.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,222.98 / $26,922.59 / $26,922.59
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,222.98 / $26,922.59 / $27,583.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,383.10 / $34,568.35 / $41,482.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,934.33 / $15,334.32 / $23,518.89