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Virginia rates for HCPCS L4205

Repair Of Orthotic Device Labor Component Per 15 Minutes (Special Coverage Instructions Apply. See Mcm: 2100.4)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.00 / $12.00 / $14.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $15.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.13 / $29.13 / $30.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $30.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.50 / $22.22 / $22.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $22.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.85 / $26.22 / $34.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.00 / $16.19 / $31.55
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $65.90
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.25 / $19.97 / $36.50
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.25 / $19.97 / $36.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.98 / $14.24 / $21.40