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Minnesota rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $141.25 / $204.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $245.47 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $245.47 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $912.01 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $323.59 / $363.08
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,737.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $389.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $245.47 / $446.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $112.20 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $147.91 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $123.03 / $288.40