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North Dakota rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.24 / $1,185.24 / $1,185.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.25 / $1,106.25 / $1,185.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,523.20 / $1,800.96 / $1,845.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,845.75 / $1,864.21 / $2,344.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.50 / $1,185.24 / $7,517.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.01 / $795.60 / $1,298.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.75 / $716.63 / $1,298.02