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North Dakota rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $77.62 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $138.04 / $151.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $208.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $125.89 / $676.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $63.10 / $125.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $204.17 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $93.33 / $154.88