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Virginia rates for HCPCS L5638

Addition to lower extremity, below knee (BK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.06 / $308.06 / $311.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.45 / $308.06 / $380.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.11 / $584.11 / $620.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.85 / $356.85 / $462.24
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.00 / $313.00 / $399.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.81 / $503.81 / $503.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.78 / $367.78 / $390.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.88 / $525.70 / $700.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.13 / $370.49 / $683.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.00 / $767.22 / $972.93
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.02 / $440.83 / $730.14
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.02 / $440.83 / $730.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.77 / $388.77 / $388.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.08 / $291.41 / $449.05