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Illinois 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
$11,104.70 / $11,104.72 / $11,104.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,779.29 / $11,104.72 / $18,408.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26,471.77 / $45,356.09 / $193,047.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $24,558.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $26,010.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,192.68 / $24,679.95 / $31,410.85
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29,167.22 / $29,167.22 / $29,167.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,672.34 / $19,531.91 / $20,508.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,332.68 / $11,193.23 / $19,215.05