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Connecticut 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
$10,643.36 / $10,643.36 / $10,643.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,529.76 / $9,875.32 / $10,665.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,971.34 / $21,898.50 / $25,054.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,489.26 / $12,489.26 / $12,790.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $14,513.81
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,234.03 / $14,234.03 / $14,234.03
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,234.03 / $14,234.03 / $20,146.62
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,986.72 / $15,986.72 / $15,986.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,337.33 / $10,924.91 / $15,408.48