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Oregon 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
$9,772.87 / $13,318.57 / $63,182.40
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,328.95 / $42,453.86 / $55,370.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,318.57 / $18,246.43 / $21,898.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,282.37 / $20,584.59 / $22,993.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,708.65 / $21,898.50 / $24,950.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,318.57 / $18,807.83 / $22,993.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $19,175.09 / $24,088.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,244.61 / $36,416.37 / $76,826.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,832.71 / $24,088.35 / $24,088.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,553.42 / $9,999.21 / $19,077.20