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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
$9,568.04 / $9,568.04 / $9,568.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,568.04 / $10,091.35 / $17,425.27
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,592.72 / $58,484.27 / $104,478.94
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,999.21 / $16,267.40 / $21,385.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,910.66 / $28,277.74 / $36,416.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,359.73 / $19,430.05 / $19,430.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $26,010.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,730.22 / $17,730.22 / $18,616.73
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,986.72 / $15,986.72 / $15,986.72
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45,545.73 / $104,478.94 / $104,478.94
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,554.10 / $11,705.58 / $21,385.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,510.78 / $11,705.58 / $21,385.25