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North Dakota rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $60.26 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $114.82 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $162.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $102.33 / $512.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $52.48 / $104.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $158.49 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $72.44 / $120.23