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Minnesota rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,862.09 / $2,570.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,951.21 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,951.21 / $2,951.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $10,964.78 / $26,302.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,890.45 / $4,365.16
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,511.38 / $10,964.78 / $20,892.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,951.21 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,479.11 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $1,949.84 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,479.11 / $3,467.37