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Virginia rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.77 / $268.77 / $271.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.89 / $268.77 / $274.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$509.60 / $509.60 / $541.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.79 / $263.79 / $342.27
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.50 / $284.50 / $284.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $274.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.72 / $458.64 / $611.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $313.42 / $571.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.00 / $669.37 / $848.84
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.20 / $384.60 / $637.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.20 / $384.60 / $637.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.89 / $254.24 / $364.74