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Minnesota rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.22 / $4,265.22 / $4,265.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,350.79 / $4,005.86 / $4,265.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,362.17 / $5,092.22 / $7,090.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.78 / $4,837.60 / $5,092.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $15,711.71 / $43,637.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,903.25 / $6,257.45 / $7,497.13
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,327.86 / $15,074.62 / $34,360.58
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,903.25 / $5,903.25 / $6,074.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,509.06 / $5,092.22 / $23,712.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.96 / $2,538.00 / $5,113.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.96 / $2,539.02 / $5,113.50