go back

Virginia rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.22 / $1,265.22 / $1,278.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.28 / $1,265.22 / $1,689.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.96 / $2,398.96 / $2,547.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.10 / $1,711.10 / $2,139.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.00 / $1,344.40 / $1,639.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,282.33 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $1,800.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.28 / $2,159.07 / $2,878.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.00 / $1,475.41 / $2,730.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,610.00 / $3,151.05 / $3,995.90
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.32 / $1,802.84 / $2,863.12
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.32 / $1,802.84 / $2,863.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,136.98 / $1,196.82 / $1,756.79