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New York 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
$8,047.40 / $9,529.76 / $17,640.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,047.40 / $9,660.77 / $13,806.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,898.50 / $22,336.47 / $43,797.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,489.26 / $12,489.26 / $34,595.25
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,967.49 / $18,244.61 / $18,244.61
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,244.61 / $18,244.61 / $18,244.61
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $21,898.50 / $49,271.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,920.12 / $16,423.88 / $39,899.07
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,165.48 / $13,988.32 / $18,244.61
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $14,513.81 / $21,898.50
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $13,534.34 / $32,512.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,283.28 / $13,213.37 / $18,408.84
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,705.58 / $13,165.48 / $13,165.48
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,165.48 / $13,165.48 / $13,988.32