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Virginia 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
$9,016.45 / $9,016.45 / $9,112.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,326.34 / $9,016.45 / $9,735.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,095.98 / $17,095.98 / $18,155.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,672.80 / $5,672.80 / $7,617.43
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,216.21 / $10,216.21 / $11,686.70
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,967.19 / $15,386.38 / $20,515.18
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,016.45 / $11,501.68 / $17,902.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,621.62 / $22,455.65 / $28,476.37
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,991.71 / $13,380.54 / $20,904.56
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,991.71 / $13,380.54 / $20,904.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,948.84 / $8,528.99 / $13,248.06