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Minnesota rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.14 / $1,596.14 / $1,596.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.51 / $1,596.14 / $1,596.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,632.41 / $1,905.61 / $2,653.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.49 / $1,810.33 / $1,905.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $5,879.35 / $16,329.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,209.13 / $2,341.67 / $2,805.59
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,490.50 / $5,640.95 / $12,857.79
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,209.13 / $2,209.13 / $2,273.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.58 / $1,905.61 / $9,329.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.05 / $950.69 / $1,913.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.05 / $861.09 / $1,913.58