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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
$9,772.37 / $9,772.37 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $10,964.78 / $19,054.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,489.63 / $13,489.63 / $13,489.63
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $22,908.68 / $22,908.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104,712.85 / $104,712.85 / $104,712.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,201.85 / $165,958.69 / $165,958.69
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $21,877.62 / $33,113.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $12,022.64 / $22,387.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $11,220.18 / $11,220.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $18,620.87 / $30,902.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $15,135.61 / $22,908.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $12,589.25 / $15,135.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68