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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
$206.20 / $206.20 / $206.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.19 / $197.07 / $206.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.89 / $246.18 / $342.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.94 / $233.87 / $246.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $759.36 / $2,109.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.38 / $302.50 / $362.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.82 / $728.57 / $1,660.68
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.38 / $285.38 / $293.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.23 / $246.18 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.43 / $117.69 / $247.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.43 / $111.65 / $247.22