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Utah 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
$6,760.83 / $6,760.83 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $8,912.51 / $74,131.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $9,772.37 / $9,772.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $10,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $12,882.50 / $16,982.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $15,488.17 / $26,915.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $12,589.25 / $19,054.61
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,848.93 / $17,782.79 / $18,197.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,882.50 / $18,197.01 / $22,387.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $10,471.29 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $7,762.47 / $12,302.69