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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
$229.09 / $229.09 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $190.55 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $354.81 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $316.23 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $158.49 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $524.81 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $234.42 / $380.19