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Virginia rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.02 / $309.02 / $312.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.02 / $309.02 / $334.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.94 / $585.94 / $622.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.30 / $355.30 / $453.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.00 / $328.36 / $400.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $379.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.16 / $527.35 / $703.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.72 / $361.55 / $673.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.00 / $769.64 / $975.99
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.02 / $440.33 / $732.43
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.02 / $440.33 / $732.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.44 / $292.32 / $450.45