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Minnesota rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.47 / $1,311.47 / $1,311.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.72 / $1,311.47 / $1,830.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,616.88 / $1,887.48 / $2,628.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.98 / $1,793.11 / $1,887.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $5,823.48 / $16,174.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,188.13 / $2,319.41 / $2,778.92
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,457.33 / $5,587.35 / $12,735.61
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,188.13 / $2,188.13 / $2,251.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.15 / $1,887.48 / $10,013.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.76 / $990.45 / $2,198.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.76 / $941.64 / $2,113.98