go back

Minnesota rates for HCPCS L5570

Preparatory, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,291.01 / $2,291.01 / $2,291.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.57 / $2,250.09 / $2,291.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,343.08 / $2,735.22 / $3,808.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,188.17 / $2,598.46 / $2,735.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,769.38 / $8,439.86 / $23,440.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,171.00 / $3,361.26 / $4,027.17
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,010.64 / $8,097.63 / $18,457.48
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,171.00 / $3,171.00 / $3,263.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$804.54 / $2,735.22 / $12,904.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.62 / $1,353.11 / $2,746.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.62 / $1,353.11 / $3,555.79