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Indiana 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
$10,677.60 / $10,677.62 / $22,436.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,677.62 / $10,955.24 / $11,164.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,724.68 / $20,080.50 / $22,436.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,240.68 / $12,489.26 / $16,860.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,918.41 / $24,679.95 / $33,654.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,070.87 / $24,679.95 / $30,289.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $22,436.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $23,015.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,666.14 / $11,193.23 / $15,408.48