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North Carolina rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,570.40 / $3,311.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $4,365.16 / $8,709.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,754.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $3,467.37
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,290.87 / $2,691.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $3,630.78 / $6,025.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,951.21 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $3,090.30
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,908.68 / $22,908.68 / $22,908.68
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,988.33 / $23,988.33 / $29,512.09