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North Dakota rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.61 / $421.61 / $421.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.61 / $647.16 / $647.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.82 / $640.63 / $656.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.88 / $904.83 / $1,137.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.89 / $465.20 / $3,076.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.87 / $433.66 / $481.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.74 / $433.66 / $687.78