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Virginia rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.72 / $339.72 / $343.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.17 / $339.72 / $343.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.15 / $644.15 / $684.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.89 / $319.89 / $410.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $360.99 / $440.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $344.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $329.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.91 / $579.74 / $772.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.85 / $396.17 / $722.75
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.00 / $846.09 / $1,072.94
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.91 / $486.13 / $805.19
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.91 / $486.13 / $805.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.42 / $321.36 / $461.03