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Minnesota rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.16 / $647.16 / $647.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.95 / $510.31 / $647.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.88 / $772.66 / $1,075.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.13 / $734.03 / $772.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $2,383.60 / $6,620.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.88 / $949.63 / $1,137.76
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.12 / $2,286.94 / $5,212.80
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.88 / $895.88 / $921.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.24 / $772.66 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $322.83 / $775.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $382.03 / $385.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $322.83 / $1,167.09