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Minnesota rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,792.59 / $18,792.59 / $18,792.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,357.61 / $17,649.90 / $18,792.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19,219.71 / $22,436.32 / $31,241.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,949.06 / $21,314.50 / $22,436.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $69,225.88 / $192,269.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,010.38 / $27,571.00 / $33,033.18
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41,098.58 / $66,418.84 / $151,392.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,010.38 / $26,010.38 / $26,765.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,648.98 / $22,436.32 / $104,478.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,666.14 / $11,182.46 / $22,530.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,666.14 / $11,165.79 / $22,530.11