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North Dakota rates for HCPCS L5683

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socket Insert For Other Than Congenital Or Atypical Traumatic Amputee Siliconegel Elastomeric Or Equal For Use With Or Without Locking Mechanism Initial Only(For Other Than I Nitial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.33 / $1,170.33 / $1,170.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.33 / $1,330.08 / $1,330.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.04 / $1,778.31 / $1,822.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,840.88 / $1,859.28 / $2,337.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.94 / $1,242.71 / $7,396.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.85 / $1,061.83 / $1,300.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.92 / $802.51 / $1,281.69