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Minnesota rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.47 / $310.47 / $310.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.16 / $310.47 / $357.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.52 / $370.68 / $516.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.54 / $352.15 / $370.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $1,144.21 / $3,177.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.75 / $455.54 / $545.78
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.31 / $1,087.20 / $2,502.33
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.75 / $429.75 / $442.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.97 / $369.09 / $1,982.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.28 / $195.77 / $398.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.28 / $199.66 / $395.38