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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
$10,715.19 / $10,715.19 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $10,964.78 / $19,952.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,378.01 / $22,387.21 / $26,915.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,589.25 / $12,882.50 / $15,135.61
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 / $10,715.19
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,125.38 / $14,125.38 / $14,125.38
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,125.38 / $15,848.93 / $21,877.62
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,848.93 / $15,848.93 / $15,848.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,964.78 / $15,488.17