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Massachusetts 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
$9,549.93 / $9,549.93 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,220.18 / $19,952.62
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,892.96 / $21,379.62 / $104,712.85
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $16,595.87 / $22,387.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,547.09 / $28,840.32 / $38,018.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $19,498.45 / $19,498.45
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 / $14,454.40
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $19,054.61 / $28,840.32
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,848.93 / $15,848.93 / $15,848.93
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,892.96 / $21,379.62 / $104,712.85
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $16,982.44 / $24,547.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15,135.61 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $15,135.61 / $19,054.61