go back

North Dakota rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,022.64 / $18,620.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,620.87 / $25,118.86 / $27,542.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,302.68 / $26,302.68 / $32,359.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $18,620.87 / $104,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $11,220.18 / $22,908.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $32,359.37 / $32,359.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $15,135.61 / $23,988.33