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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
$10,715.19 / $10,715.19 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $11,220.18 / $16,982.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $22,908.68 / $28,840.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $12,589.25 / $22,387.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,387.21 / $28,183.83 / $33,884.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $22,908.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $19,498.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $15,848.93 / $17,782.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $11,220.18 / $15,488.17