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Missouri 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
$10,200.16 / $15,087.73 / $15,570.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,200.16 / $11,687.68 / $21,250.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,326.11 / $23,442.42 / $103,057.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,396.48 / $12,489.26 / $18,364.04
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 / $15,472.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,200.16 / $17,993.05 / $104,478.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,332.68 / $11,934.15 / $19,820.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,332.68 / $11,138.25 / $15,810.25