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North Dakota rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $346.74 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $630.96 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $575.44 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $933.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $426.58 / $812.83