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Virginia rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.40 / $341.40 / $345.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.41 / $341.40 / $377.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.30 / $647.30 / $687.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.40 / $352.40 / $454.63
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.00 / $347.00 / $442.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.12 / $582.58 / $776.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $398.11 / $726.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.00 / $850.25 / $1,078.21
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.65 / $488.53 / $809.14
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.65 / $488.53 / $809.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.30 / $382.03 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.88 / $322.94 / $463.30