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Minnesota rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.78 / $490.78 / $490.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.04 / $490.78 / $568.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.94 / $585.94 / $815.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.75 / $556.64 / $585.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $1,808.39 / $5,022.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.13 / $719.87 / $862.49
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,073.61 / $1,735.06 / $3,954.85
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.13 / $679.13 / $699.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.38 / $582.54 / $3,128.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $326.91 / $631.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $299.83 / $625.55