go back

Virginia rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.66 / $133.86 / $157.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.19 / $137.30 / $215.77
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.15 / $142.63 / $278.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.79 / $160.43 / $299.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.87 / $137.82 / $174.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $100.14 / $185.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.28 / $135.34 / $264.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.92 / $159.38 / $248.13