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North Dakota rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,516.07 / $3,516.07 / $3,516.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,516.07 / $4,632.92 / $4,632.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,518.64 / $5,342.63 / $5,475.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,412.50 / $6,476.63 / $8,143.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,115.87 / $4,554.54 / $25,854.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.31 / $3,616.52 / $4,018.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.24 / $3,823.86 / $6,858.69