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California 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
Facility
Modifier
Low / Median / High Price
$12,037.88 / $12,037.88 / $63,182.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,630.76 / $12,037.88 / $63,182.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,141.23 / $33,223.80 / $69,512.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,240.68 / $12,489.26 / $20,865.78
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $25,925.84 / $46,296.14
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $29,055.59 / $67,680.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $17,396.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $15,472.44
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,705.58 / $14,046.70 / $24,088.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,139.10 / $15,328.95 / $33,285.72
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,693.01 / $104,478.94 / $104,478.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,957.80 / $112,957.80 / $164,238.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46,239.36 / $46,239.36 / $46,239.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $19,748.22 / $22,555.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $20,843.32
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41,332.58 / $41,332.58 / $41,332.58
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,705.58 / $17,518.80 / $17,558.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,412.24 / $10,924.91 / $19,774.09