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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
$10,232.93 / $15,135.61 / $15,135.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,748.98 / $32,359.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $79,432.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $12,589.25 / $20,892.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,803.84 / $13,803.84 / $22,908.68
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $17,782.79 / $50,118.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $11,220.18 / $112,201.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $17,782.79 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $11,220.18 / $15,848.93