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Maine 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
$10,665.35 / $14,748.63 / $14,748.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,476.53 / $25,233.64 / $46,775.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,489.26 / $12,790.21 / $16,440.39
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,730.22 / $17,730.22 / $17,730.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,330.29 / $14,748.63 / $14,748.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,704.24 / $15,408.48 / $25,123.92