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Arizona rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,220.18 / $43,651.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $13,182.57 / $27,542.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $21,877.62 / $41,686.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $14,791.08 / $45,708.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $10,000.00 / $112,201.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $15,488.17 / $17,378.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $10,000.00 / $15,135.61