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Connecticut 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
$5,011.87 / $5,011.87 / $5,011.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,011.87 / $9,120.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,128.31 / $10,471.29 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,888.44 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $7,413.10 / $10,471.29
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,128.61 / $7,079.46