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North Dakota rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.82 / $162.82 / $162.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.82 / $206.20 / $206.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.24 / $247.40 / $253.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.38 / $288.23 / $362.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.98 / $206.20 / $1,197.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.16 / $167.47 / $186.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.43 / $167.47 / $246.18