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Oklahoma 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
$7,555.38 / $7,555.38 / $7,555.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,555.38 / $8,634.71 / $8,716.34
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
$8,340.66 / $9,812.54 / $9,812.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,310.92 / $11,501.68 / $81,836.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,222.91 / $10,352.65 / $17,196.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,222.91 / $8,393.33 / $12,169.09