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Maryland 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
Professional
Modifier
Low / Median / High Price
$9,397.00 / $10,738.05 / $17,508.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,168.77 / $13,168.77 / $14,969.68
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 / $10,595.08 / $14,513.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,328.95 / $21,898.50 / $31,533.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,864.23 / $11,471.16 / $17,323.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,128.12 / $12,128.12 / $15,328.95