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Minnesota rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,632.92 / $4,632.92 / $4,632.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,340.44 / $4,255.76 / $4,632.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,738.21 / $5,531.20 / $7,702.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,424.96 / $5,254.64 / $5,531.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $17,065.93 / $47,399.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,412.50 / $6,797.25 / $8,143.88
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,131.84 / $16,373.93 / $37,322.19
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,412.50 / $6,412.50 / $6,598.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,603.21 / $5,531.20 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.34 / $2,661.63 / $5,554.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.80 / $4,018.36 / $10,043.75