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North Carolina rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.26 / $211.26 / $428.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.29 / $211.26 / $211.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.57 / $273.08 / $518.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.78 / $212.87 / $212.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $175.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $140.44 / $285.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $211.26 / $317.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $200.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.89 / $273.89 / $421.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.79 / $141.61 / $211.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.54 / $1,417.31 / $1,417.31
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,753.07 / $1,753.07 / $1,753.07