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North Carolina rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,073.84 / $3,073.84 / $6,238.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,915.68 / $3,073.84 / $3,073.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,716.90 / $3,716.90 / $3,716.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,762.29 / $6,126.10 / $7,544.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,354.04 / $3,097.42 / $3,097.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $2,554.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $5,325.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.38 / $3,073.84 / $4,650.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,322.00 / $2,322.00 / $2,898.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,984.39 / $4,984.39 / $7,663.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.97 / $2,069.09 / $3,223.60
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,775.58 / $25,846.18 / $25,846.18
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,362.41 / $26,362.41 / $31,152.60