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North Dakota rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.57 / $316.57 / $316.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.57 / $403.85 / $403.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.84 / $481.02 / $492.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.13 / $564.72 / $710.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.58 / $364.82 / $2,359.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.35 / $325.61 / $361.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.72 / $325.61 / $361.79