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Virginia rates for HCPCS L2628

Addition To Lower Extremity Pelvic Control Metal Frame Reciprocating Hip Joint And Cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$819.55 / $990.07 / $990.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.55 / $990.07 / $1,077.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,002.40 / $2,002.40 / $2,126.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.16 / $1,137.16 / $1,500.32
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.00 / $1,074.00 / $1,368.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $860.97 / $1,179.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.68 / $1,802.16 / $2,402.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.91 / $1,231.51 / $2,248.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.00 / $2,503.00 / $3,335.36
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.06 / $1,511.20 / $2,389.84
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,097.06 / $1,511.20 / $2,389.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.00 / $998.98 / $1,504.81