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Maryland 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
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,370.32 / $8,709.64
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 / $6,606.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $10,232.93 / $15,488.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,918.31 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $5,128.61 / $7,943.28
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $8,511.38