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Minnesota rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.05 / $94.05 / $94.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.24 / $84.85 / $94.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.18 / $112.28 / $156.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.82 / $106.67 / $112.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $346.57 / $962.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.13 / $137.93 / $165.26
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.76 / $332.52 / $757.94
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.13 / $130.13 / $134.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.96 / $112.28 / $510.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $53.67 / $112.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.04 / $52.38 / $112.75