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Wyoming 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
$11,341.15 / $11,341.15 / $19,861.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,150.67 / $22,150.67 / $22,150.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,150.67 / $22,150.67 / $22,150.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $24,558.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $14,513.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,037.45 / $9,999.21 / $15,408.48