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North Carolina rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.06 / $251.06 / $509.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.90 / $251.06 / $251.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.31 / $500.37 / $616.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.28 / $253.00 / $253.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.65 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $396.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $251.06 / $379.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $190.00 / $237.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.50 / $491.50 / $755.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.36 / $168.29 / $251.47
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.37 / $2,016.23 / $2,016.23
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.46 / $2,062.46 / $3,071.85