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Minnesota rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,675.58 / $3,675.58 / $3,675.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,015.81 / $3,491.58 / $3,675.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,759.12 / $4,388.25 / $6,110.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,510.60 / $4,168.84 / $4,388.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $13,540.19 / $37,606.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,087.25 / $5,392.49 / $6,460.81
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,038.65 / $12,991.15 / $29,611.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,087.25 / $5,087.25 / $5,235.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.32 / $4,388.25 / $20,802.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.72 / $2,097.86 / $4,406.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.72 / $2,189.23 / $4,406.58