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Pennsylvania 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
$9,779.29 / $9,779.29 / $37,845.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,569.67 / $10,354.54 / $13,343.73
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,674.66 / $21,898.50 / $21,898.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $21,898.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $19,175.09
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,146.62 / $21,898.50 / $41,607.15
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,779.29 / $9,779.29 / $37,845.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,569.67 / $10,738.05 / $17,798.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,151.40 / $31,224.10 / $43,144.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $21,898.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $26,010.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,656.51 / $20,843.32 / $20,843.32
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,656.51 / $20,843.32 / $21,355.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,874.11 / $11,894.01 / $18,208.18