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North Carolina rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.27 / $296.27 / $601.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.07 / $296.27 / $296.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.62 / $590.45 / $727.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.89 / $298.54 / $298.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.22 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $548.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $296.27 / $468.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.00 / $224.00 / $280.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.80 / $505.80 / $777.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.57 / $198.59 / $306.01
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.11 / $2,322.98 / $2,322.98
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,347.44 / $2,347.44 / $3,161.55