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North Carolina rates for HCPCS L5656

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.80 / $336.80 / $683.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.01 / $336.80 / $336.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.82 / $435.38 / $826.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.94 / $339.39 / $339.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.92 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.94 / $245.16 / $601.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.40 / $336.80 / $509.60
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.00 / $254.00 / $318.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.30 / $698.30 / $1,073.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.45 / $225.76 / $347.88
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.82 / $2,819.79 / $2,819.79
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,938.52 / $2,938.52 / $4,364.10