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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
$16,789.61 / $16,789.61 / $34,074.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,091.35 / $16,789.61 / $16,789.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,085.83 / $21,703.00 / $41,208.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,704.80 / $16,918.41 / $16,918.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $26,010.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $16,789.61 / $25,088.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,826.18 / $15,826.18 / $15,826.18
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,278.20 / $26,278.20 / $40,403.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,646.37 / $11,253.89 / $16,318.14
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37,693.01 / $104,478.94 / $104,478.94
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,957.80 / $164,238.75 / $164,238.75