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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
$9,772.37 / $38,018.94 / $38,018.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,220.18 / $19,054.61
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,877.62 / $21,877.62 / $21,877.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $22,387.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,417.38 / $29,512.09 / $42,657.95
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,387.21 / $22,387.21 / $22,387.21
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,489.63 / $15,488.17 / $22,387.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $38,018.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $11,481.54 / $19,952.62
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35,481.34 / $35,481.34 / $35,481.34
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $30,902.95 / $42,657.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $20,892.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $21,379.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $27,542.29 / $32,359.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $11,748.98 / $19,952.62