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North Dakota rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.70 / $2,884.70 / $2,884.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.70 / $3,675.58 / $3,675.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,707.25 / $4,383.28 / $4,492.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,087.25 / $5,138.12 / $6,460.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,989.66 / $3,675.58 / $20,802.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,579.59 / $2,967.12 / $3,296.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.72 / $2,967.12 / $4,705.83