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Texas 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
$9,875.32 / $9,875.32 / $10,665.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,875.32 / $10,665.35 / $19,750.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,430.44 / $13,430.44 / $13,430.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,555.79 / $22,555.79 / $22,555.79
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,693.01 / $104,478.94 / $104,478.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,957.80 / $112,957.80 / $164,238.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $16,933.86 / $22,555.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,528.17 / $20,300.21 / $22,555.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $15,071.15 / $22,555.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $15,472.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,332.68 / $12,326.78 / $15,171.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,128.12 / $12,489.26 / $22,555.79