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Minnesota rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.99 / $458.99 / $458.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.38 / $410.10 / $458.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.42 / $547.98 / $763.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.38 / $520.58 / $547.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $1,690.45 / $4,695.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.25 / $673.37 / $806.77
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.60 / $1,621.91 / $3,696.93
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.25 / $635.25 / $653.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.77 / $547.98 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $243.58 / $550.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $243.58 / $564.41