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Virginia rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.75 / $177.75 / $179.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.05 / $177.75 / $191.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.02 / $337.02 / $357.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.58 / $201.58 / $251.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.00 / $181.00 / $230.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $221.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.91 / $303.32 / $404.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $213.33 / $383.64
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $442.68 / $561.37
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.65 / $253.28 / $421.28
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.65 / $253.28 / $421.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.97 / $168.14 / $244.74