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North Dakota rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,548.58 / $7,548.58 / $7,548.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,548.58 / $8,613.23 / $8,613.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,700.98 / $11,469.98 / $11,755.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,921.25 / $12,040.46 / $15,139.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,526.18 / $8,047.56 / $48,028.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,133.42 / $6,902.48 / $8,390.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,067.77 / $6,902.48 / $10,947.27