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Virginia rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,408.08 / $2,408.08 / $2,433.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.92 / $2,408.08 / $2,810.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,565.92 / $4,565.92 / $4,849.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,776.59 / $2,776.59 / $3,627.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.00 / $2,558.77 / $3,121.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,440.66 / $2,853.06 / $2,853.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,082.73 / $2,853.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,196.14 / $4,109.33 / $5,479.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,470.57 / $2,896.13 / $5,197.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,567.00 / $5,997.37 / $7,605.36
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,501.53 / $3,431.32 / $5,449.34
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,501.53 / $3,431.32 / $5,449.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.79 / $2,277.89 / $3,510.16