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Virginia rates for HCPCS L5639

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$722.69 / $722.69 / $730.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.29 / $722.69 / $768.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.29 / $1,370.29 / $1,455.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.12 / $822.12 / $1,060.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.00 / $735.00 / $936.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $635.47 / $870.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.20 / $1,233.26 / $1,644.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.41 / $842.74 / $1,559.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.00 / $1,799.88 / $2,282.46
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.74 / $1,034.14 / $1,750.61
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.74 / $1,034.14 / $1,750.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.86 / $683.62 / $1,034.53