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Minnesota rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $131.83 / $199.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $234.42 / $346.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $870.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $309.03 / $346.74
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,659.59
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $371.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $234.42 / $426.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $109.65 / $263.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $147.91 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $120.23 / $275.42