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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
$6,693.00 / $6,693.00 / $6,693.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,693.00 / $6,693.00 / $49,326.00
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 / $9,812.54 / $10,106.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,014.85 / $12,927.18 / $16,805.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,505.62 / $17,292.83 / $17,292.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,847.14 / $12,395.50 / $18,593.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,301.45 / $7,834.36 / $12,169.09