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Ohio 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
$10,955.24 / $10,955.24 / $26,322.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,677.62 / $10,955.24 / $15,087.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,067.70 / $24,679.95 / $63,943.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,240.68 / $12,489.26 / $29,167.21
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,827.24 / $22,436.32 / $30,289.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,662.63 / $20,302.09 / $48,040.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $26,435.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $18,541.39
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $14,513.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,462.16 / $11,193.23 / $15,858.68