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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
$16,502.41 / $16,502.41 / $16,502.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,502.41 / $18,792.59 / $18,792.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,207.94 / $25,075.27 / $25,699.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,010.38 / $26,270.48 / $33,033.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,875.32 / $18,408.09 / $104,478.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,036.32 / $14,998.82 / $18,343.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,829.28 / $9,999.21 / $18,072.64