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Minnesota rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,097.59 / $2,097.59 / $2,097.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.90 / $1,845.01 / $2,097.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,145.27 / $2,504.29 / $3,487.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,003.43 / $2,379.08 / $2,504.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $7,727.05 / $21,461.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,903.25 / $3,077.45 / $3,687.13
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,587.46 / $7,413.73 / $16,898.61
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,903.25 / $2,903.25 / $2,987.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.53 / $2,504.29 / $11,250.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.32 / $1,165.19 / $2,514.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,365.94 / $2,783.46 / $3,340.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.32 / $1,162.99 / $2,514.77