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California rates for HCPCS L5859

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,735.27 / $9,735.27 / $49,326.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,439.81 / $9,735.27 / $49,326.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,254.60 / $22,224.77 / $54,267.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,672.80 / $5,672.80 / $16,289.71
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.20 / $20,915.13 / $37,348.44
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $22,683.46 / $52,837.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $13,581.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $8,340.66 / $10,106.92
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,676.78 / $17,095.98 / $20,515.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,257.59 / $11,967.19 / $25,985.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,426.58 / $81,836.25 / $81,836.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89,678.01 / $89,678.01 / $128,219.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36,098.67 / $36,098.67 / $36,098.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,003.09 / $17,095.98 / $17,950.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $9,812.54 / $16,854.61
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32,268.02 / $32,268.02 / $32,268.02
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,676.78 / $13,676.78 / $13,676.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,374.47 / $8,452.92 / $16,547.48