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Minnesota rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$662.27 / $662.27 / $662.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.54 / $588.53 / $662.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.32 / $790.68 / $1,101.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.54 / $751.15 / $790.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $2,439.46 / $6,775.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.50 / $971.49 / $1,163.96
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,448.28 / $2,340.55 / $5,334.98
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.50 / $916.50 / $943.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.71 / $790.68 / $3,490.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $378.05 / $793.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $373.02 / $793.99