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North Dakota rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.93 / $363.93 / $363.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.93 / $458.99 / $458.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.70 / $552.98 / $566.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.25 / $641.60 / $806.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.07 / $363.93 / $2,323.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.53 / $326.57 / $404.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.37 / $249.55 / $517.95