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Illinois 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
$8,669.35 / $8,669.35 / $8,669.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,634.61 / $8,669.35 / $14,803.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,120.88 / $84,341.06 / $183,958.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,312.02 / $13,312.02 / $13,312.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $19,172.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $9,812.54 / $20,306.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,012.66 / $16,277.83 / $19,354.98
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,770.57 / $22,770.57 / $22,770.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,673.86 / $15,248.38 / $16,010.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,668.73 / $8,738.45 / $14,930.75