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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
$457.09 / $457.09 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $457.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $549.54 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $549.54 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $2,041.74 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $724.44 / $812.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,949.84 / $3,890.45
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $870.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $549.54 / $977.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $229.09 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $288.40 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $251.19 / $645.65