go back

Minnesota rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.44 / $396.44 / $396.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.77 / $350.52 / $396.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.45 / $473.30 / $659.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.64 / $449.64 / $473.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $1,460.78 / $4,057.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.63 / $581.54 / $696.75
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.25 / $1,401.55 / $3,194.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.63 / $548.63 / $564.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.05 / $473.30 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $221.76 / $475.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $198.59 / $475.28