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Michigan 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
$10,003.09 / $10,003.09 / $10,003.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,309.19 / $10,003.09 / $10,003.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,515.82 / $17,515.82 / $17,515.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,640.03 / $17,515.82 / $23,646.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,112.39 / $11,385.28 / $11,447.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,012.66 / $14,012.66 / $14,012.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $9,812.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $20,306.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,003.09 / $11,980.36 / $11,980.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,003.09 / $11,980.36 / $17,560.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,017.45 / $12,961.71 / $14,905.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,528.64 / $8,373.68 / $13,057.27