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Virginia rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.69 / $347.69 / $351.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.07 / $347.69 / $364.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.24 / $659.24 / $700.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.82 / $405.82 / $507.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.04 / $369.45 / $450.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $436.96 / $436.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $318.98 / $436.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.47 / $593.32 / $791.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.58 / $405.45 / $750.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.00 / $865.92 / $1,098.08
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.18 / $499.01 / $825.48
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.18 / $499.01 / $825.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.95 / $328.89 / $484.55