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Minnesota rates for HCPCS L8415

Prosthetic sheath, upper limb, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.55 / $21.55 / $21.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $21.55 / $22.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.04 / $25.73 / $35.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.58 / $24.44 / $25.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $79.66 / $221.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $31.80 / $38.10
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.29 / $76.43 / $174.21
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.52 / $25.73 / $134.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.56 / $13.50 / $27.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.56 / $13.86 / $34.74