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North Carolina rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.83 / $418.83 / $849.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.74 / $418.83 / $418.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.63 / $834.72 / $1,027.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.76 / $422.05 / $422.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $648.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $418.83 / $633.69
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $315.00 / $395.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.50 / $655.50 / $1,007.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.68 / $280.73 / $440.42
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.25 / $2,615.79 / $2,615.79
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,817.63 / $2,817.63 / $4,096.72