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Minnesota rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.09 / $639.09 / $639.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.75 / $503.93 / $639.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.62 / $763.01 / $1,062.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.41 / $724.86 / $763.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $2,354.64 / $6,539.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.63 / $937.70 / $1,123.47
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,397.92 / $2,259.16 / $5,149.45
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.63 / $884.63 / $910.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.84 / $763.01 / $3,080.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.33 / $318.80 / $766.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.55 / $763.01 / $915.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.33 / $317.22 / $766.20