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Virginia rates for HCPCS L2650

Addition To Lower Extremity Pelvic And Thoracic Control Gluteal Pad Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.97 / $79.70 / $79.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.97 / $79.70 / $89.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.19 / $161.19 / $171.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.80 / $82.80 / $105.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.00 / $86.00 / $110.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.36 / $112.36 / $112.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.02 / $82.02 / $112.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.84 / $145.08 / $193.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.54 / $95.00 / $180.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.00 / $201.50 / $268.50
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.98 / $121.65 / $201.50
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.98 / $121.65 / $201.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.24 / $80.42 / $121.14