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North Dakota rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,682.85 / $2,682.85 / $2,682.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.73 / $2,463.73 / $2,682.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,447.84 / $4,076.56 / $4,177.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,409.88 / $3,443.97 / $4,330.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.09 / $2,682.85 / $15,444.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.88 / $2,201.17 / $2,938.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.00 / $2,201.17 / $3,491.04