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Virginia rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.81 / $25.14 / $25.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.81 / $25.14 / $29.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.84 / $50.84 / $53.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $27.25 / $36.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.71 / $26.71 / $34.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $34.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $34.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.59 / $45.76 / $61.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $31.27 / $57.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $63.55 / $84.68
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.12 / $38.36 / $64.95
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.12 / $38.36 / $64.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.08 / $25.37 / $38.11