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South Carolina 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
$7,943.28 / $7,943.28 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $8,709.64 / $13,182.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,782.79 / $19,054.61 / $22,387.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $28,183.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $20,417.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $11,481.54 / $28,183.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $11,481.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $11,748.98 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $8,709.64 / $12,302.69