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North Dakota rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.62 / $231.62 / $231.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.62 / $286.23 / $286.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.66 / $351.94 / $360.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.00 / $399.96 / $502.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.16 / $286.23 / $1,741.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.83 / $238.24 / $264.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.88 / $238.24 / $264.70