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Tennessee 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
$7,482.88 / $7,629.61 / $7,629.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,469.69 / $7,629.61 / $13,107.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,492.66 / $15,849.69 / $15,849.69
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 / $8,340.66 / $9,812.54
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,516.83 / $81,836.25 / $81,836.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89,678.01 / $89,678.01 / $128,219.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,857.21 / $8,785.82 / $12,169.09