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Minnesota rates for HCPCS L5859

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,791.08 / $14,791.08 / $14,791.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $9,772.37 / $14,791.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $17,378.01 / $25,703.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,125.38 / $17,378.01 / $17,378.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,018.94 / $66,069.34 / $158,489.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,417.38 / $22,908.68 / $25,703.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $64,565.42 / $123,026.88
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,417.38 / $20,417.38 / $27,542.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $17,378.01 / $31,622.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $7,762.47 / $19,054.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $10,471.29 / $21,379.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $8,709.64 / $20,417.38