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Vermont 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
$9,549.93 / $12,022.64 / $13,803.84
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 / $15,488.17
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,982.44 / $21,379.62 / $26,915.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $16,595.87 / $45,708.82