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Texas 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
$7,709.58 / $7,709.58 / $8,326.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,709.58 / $8,326.34 / $15,419.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,485.02 / $10,485.02 / $10,485.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,419.15 / $15,419.15 / $17,609.11
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
$29,426.58 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,836.06 / $14,967.74 / $17,609.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,501.68 / $16,200.38 / $18,116.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,234.04 / $11,501.68 / $17,609.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,340.66 / $8,340.66 / $14,214.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,528.64 / $9,735.28 / $12,169.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,672.80 / $9,476.36 / $17,609.11