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North Carolina rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.71 / $115.71 / $234.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.55 / $115.71 / $115.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.91 / $139.91 / $139.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.65 / $149.58 / $283.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.23 / $116.60 / $128.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $179.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $115.71 / $173.34
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.06 / $109.06 / $109.06
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.10 / $181.10 / $278.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.59 / $77.56 / $112.46
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.81 / $720.06 / $720.06
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.52 / $1,131.90 / $1,131.90