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Virginia rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.22 / $191.14 / $191.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.22 / $191.14 / $218.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.59 / $386.59 / $410.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.09 / $210.09 / $272.67
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.00 / $207.00 / $264.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.64 / $215.87 / $215.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.59 / $157.59 / $215.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.61 / $347.93 / $463.91
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.27 / $237.75 / $433.75
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.00 / $483.24 / $643.92
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.80 / $291.75 / $483.24
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.80 / $291.75 / $483.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.50 / $192.86 / $289.77