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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
$1,706.30 / $1,706.30 / $1,706.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$940.43 / $1,602.53 / $1,706.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.08 / $2,037.14 / $2,836.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,629.71 / $1,935.28 / $2,037.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $6,285.93 / $17,458.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.75 / $2,503.46 / $2,999.42
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,731.88 / $6,031.04 / $13,746.95
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.75 / $2,361.75 / $2,430.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$603.69 / $2,037.14 / $9,502.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.26 / $1,015.32 / $2,045.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.26 / $973.88 / $2,045.65