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North Carolina rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $512.86 / $588.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $575.44 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $446.68 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $380.19 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $467.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $346.74 / $389.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $489.78 / $851.14
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
$245.47 / $436.52 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $295.12 / $446.68
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $5,888.44