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North Carolina rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,250.32 / $2,250.32 / $4,566.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,352.55 / $2,250.32 / $2,250.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.33 / $4,484.84 / $5,523.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,723.36 / $2,267.58 / $2,267.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,870.22 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $3,409.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$947.36 / $2,250.32 / $3,404.78
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.00 / $1,700.00 / $2,122.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,529.70 / $3,529.70 / $5,427.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.03 / $1,508.36 / $2,261.29
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,882.87 / $18,629.07 / $18,629.07
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,825.16 / $18,825.16 / $22,060.73