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Minnesota rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.48 / $319.48 / $319.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.14 / $319.48 / $319.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.75 / $381.43 / $531.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.14 / $362.36 / $381.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $1,177.32 / $3,269.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.13 / $468.65 / $561.50
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.96 / $1,129.58 / $2,574.73
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.13 / $442.13 / $455.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.54 / $381.43 / $2,003.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.86 / $212.90 / $407.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.86 / $190.30 / $386.63