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Washington, DC 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
$5,370.32 / $5,370.32 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $4,897.79 / $6,918.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $7,079.46
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 / $6,918.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $14,454.40 / $19,952.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,135.61 / $15,135.61 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $5,011.87 / $7,585.78