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North Carolina rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,464.02 / $2,464.02 / $5,000.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,480.99 / $2,464.02 / $2,464.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,015.91 / $4,910.75 / $6,047.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.02 / $2,482.92 / $2,482.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,047.84 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $4,449.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $2,464.02 / $3,922.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.00 / $1,861.00 / $2,323.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,253.39 / $4,253.39 / $6,539.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.54 / $2,182.50 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $1,658.61 / $2,591.09
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,128.97 / $20,966.93 / $20,966.93
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,077.76 / $23,077.76 / $26,583.68