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Virginia rates for HCPCS L5629

Addition To Lower Extremity Below Knee Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.18 / $260.70 / $260.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.83 / $260.70 / $263.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.32 / $494.32 / $524.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.73 / $231.73 / $299.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.00 / $265.00 / $265.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $264.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $248.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.02 / $444.89 / $593.17
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $304.02 / $552.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.00 / $649.29 / $823.38
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.82 / $371.48 / $617.90
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.82 / $371.48 / $617.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.62 / $246.61 / $353.79