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North Dakota rates for HCPCS L5859

Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered and programmable flexion/extension assist control, includes any type motor(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,883.29 / $12,883.29 / $12,883.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,883.29 / $14,671.20 / $14,671.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,556.84 / $19,576.04 / $20,063.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,306.25 / $20,509.31 / $25,788.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,846.73 / $14,166.29 / $81,836.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,054.58 / $11,751.54 / $14,320.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,222.91 / $11,751.54 / $14,109.15