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Minnesota rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $338.84 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,258.93 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $501.19
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $2,398.83
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $537.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $338.84 / $616.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $346.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $208.93 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $169.82 / $398.11