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North Carolina rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.46 / $440.46 / $893.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.74 / $440.46 / $440.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.11 / $877.82 / $1,081.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.31 / $443.84 / $443.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.06 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $772.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $440.46 / $701.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.00 / $333.00 / $416.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.10 / $710.10 / $1,091.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.83 / $295.24 / $463.18
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.28 / $3,747.94 / $3,747.94
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,477.91 / $4,477.91 / $4,477.91