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North Dakota rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.55 / $430.55 / $430.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.55 / $557.92 / $557.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.32 / $654.21 / $670.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.13 / $779.85 / $980.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.94 / $542.17 / $3,128.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.76 / $442.85 / $492.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.16 / $471.52 / $825.96