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Minnesota rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.64 / $219.64 / $219.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.93 / $214.65 / $219.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.63 / $262.23 / $365.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.78 / $249.12 / $262.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $809.02 / $2,246.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.13 / $322.37 / $386.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.30 / $776.21 / $1,769.28
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.13 / $304.13 / $312.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.87 / $262.23 / $1,295.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $134.18 / $263.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.06 / $135.96 / $521.90