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Virginia rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,402.02 / $2,402.02 / $2,427.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,971.56 / $2,402.02 / $2,504.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,554.43 / $4,554.43 / $4,836.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.31 / $2,547.31 / $3,235.42
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,442.00 / $2,442.00 / $3,113.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $3,006.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,194.96 / $2,194.96 / $3,006.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,188.11 / $4,099.00 / $5,465.33
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.91 / $2,801.06 / $5,110.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,345.00 / $5,982.29 / $7,586.23
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,495.23 / $3,422.69 / $5,435.64
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.23 / $3,422.69 / $5,435.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,080.16 / $2,272.16 / $3,422.69