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Minnesota rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,041.74 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,041.74 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,585.78 / $18,197.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,691.53 / $3,019.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $7,585.78 / $14,454.40
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,235.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $2,041.74 / $3,715.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $1,202.26 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,023.29 / $2,398.83