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Pennsylvania 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
$7,634.61 / $7,634.61 / $29,545.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,690.27 / $8,083.71 / $10,778.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,017.77 / $17,095.98 / $17,095.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $17,095.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $8,340.66 / $14,969.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,728.30 / $17,095.98 / $32,482.36
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,544.06 / $11,544.06 / $11,544.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,634.61 / $7,634.61 / $29,545.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,690.27 / $8,383.10 / $13,895.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,694.20 / $33,682.10 / $33,682.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,812.54 / $9,812.54 / $17,095.98
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $8,340.66 / $20,306.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,320.70 / $16,272.21 / $16,272.21
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,320.70 / $16,272.21 / $16,671.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,948.84 / $9,933.40 / $14,937.11