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Virginia rates for HCPCS L5658

Addition To Lower Extremity Socket Insert Above Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.84 / $243.84 / $246.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.35 / $243.84 / $267.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.35 / $462.35 / $491.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.11 / $266.11 / $342.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $248.00 / $316.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.64 / $416.12 / $554.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $292.08 / $518.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.00 / $607.29 / $770.12
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.30 / $347.46 / $577.94
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.30 / $347.46 / $577.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.26 / $230.66 / $335.50