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North Carolina rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$455.43 / $455.43 / $924.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.07 / $455.43 / $455.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.58 / $588.70 / $1,117.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.78 / $458.92 / $458.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $895.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $455.43 / $689.53
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.00 / $344.00 / $430.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.00 / $718.00 / $1,104.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.75 / $382.03 / $445.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.02 / $305.27 / $457.75
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,298.07 / $3,076.44 / $3,076.44
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,592.02 / $3,592.02 / $4,487.55