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Virginia rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,551.32 / $1,551.32 / $1,567.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.42 / $1,551.32 / $1,679.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,941.43 / $2,941.43 / $3,123.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.71 / $1,788.71 / $2,302.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,577.00 / $1,577.00 / $2,010.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $1,902.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.00 / $2,647.29 / $3,529.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$947.36 / $1,809.03 / $3,382.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.00 / $3,863.59 / $4,899.47
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,611.52 / $2,219.87 / $3,510.54
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.52 / $2,219.87 / $3,510.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.86 / $1,467.45 / $2,261.29