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Maine 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
Professional
Modifier
Low / Median / High Price
$7,762.47 / $8,912.51 / $11,481.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $20,417.38 / $22,908.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,791.08 / $14,791.08 / $17,782.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,715.19 / $16,595.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $10,471.29 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $12,302.69 / $16,595.87