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Minnesota rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,454.71 / $3,890.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,570.88 / $6,760.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $4,570.88 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $16,982.44 / $40,738.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,025.60 / $6,760.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $16,982.44 / $32,359.37
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $7,244.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,570.88 / $8,317.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,041.74 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $2,691.53 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,290.87 / $5,370.32