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Minnesota rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.75 / $794.75 / $794.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.86 / $706.27 / $794.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.81 / $948.84 / $1,321.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.07 / $901.40 / $948.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $2,927.78 / $8,131.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.88 / $1,165.86 / $1,396.84
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.19 / $2,809.06 / $6,402.88
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.88 / $1,099.88 / $1,132.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.06 / $948.84 / $4,189.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.35 / $497.90 / $952.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $447.47 / $952.80