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North Dakota rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.74 / $113.74 / $113.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.74 / $129.54 / $129.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.16 / $172.82 / $177.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.25 / $181.04 / $227.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.82 / $113.74 / $720.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.28 / $103.83 / $151.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.94 / $103.37 / $163.94