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Minnesota rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $8,709.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,232.93 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,232.93 / $10,232.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,387.21 / $38,904.51 / $91,201.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $13,489.63 / $15,135.61
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,512.09 / $38,018.94 / $72,443.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $12,022.64 / $16,218.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $10,232.93 / $18,620.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,570.88 / $11,220.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $6,025.60 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $5,128.61 / $12,022.64