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North Dakota rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.16 / $291.16 / $291.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.16 / $396.44 / $396.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.18 / $442.41 / $453.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.63 / $554.11 / $696.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.16 / $390.89 / $2,089.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.43 / $297.88 / $330.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $297.88 / $472.43