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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
$18,620.87 / $18,620.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,022.64 / $18,620.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,877.62 / $22,387.21 / $33,113.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,782.79 / $22,387.21 / $22,387.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48,977.88 / $85,113.80 / $199,526.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $29,512.09 / $33,113.11
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $81,283.05 / $158,489.32
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $26,302.68 / $35,481.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $22,387.21 / $45,708.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $10,000.00 / $24,547.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $13,182.57 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $11,220.18 / $26,302.68