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Minnesota rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,821.74 / $4,821.74 / $4,821.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,096.46 / $4,429.22 / $4,821.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,931.33 / $5,756.63 / $8,015.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,605.30 / $5,468.80 / $5,756.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $17,762.18 / $49,332.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,673.50 / $7,073.91 / $8,475.35
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,545.20 / $17,041.95 / $38,844.86
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,673.50 / $6,673.50 / $6,867.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,514.69 / $5,756.63 / $24,371.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.59 / $2,548.46 / $5,780.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.59 / $2,548.46 / $5,780.70