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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
$286.23 / $286.23 / $286.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $280.35 / $286.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.73 / $341.73 / $475.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.38 / $324.64 / $341.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $1,054.21 / $2,927.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.00 / $419.76 / $502.92
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.87 / $1,001.68 / $2,305.48
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.00 / $396.00 / $407.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.61 / $341.73 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $170.48 / $343.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $158.83 / $343.16