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North Carolina rates for HCPCS L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $16,982.44 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,882.50 / $16,982.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,620.87 / $22,387.21 / $44,668.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,982.44 / $17,378.01 / $19,054.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $26,302.68
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,471.29 / $11,220.18 / $14,791.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,332.54 / $17,782.79 / $31,622.78
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $15,135.61 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,912.51 / $11,220.18 / $15,848.93
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104,712.85 / $104,712.85 / $104,712.85
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,201.85 / $165,958.69 / $165,958.69