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Virginia rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.31 / $64.31 / $64.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.79 / $64.31 / $78.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.93 / $121.93 / $129.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.98 / $80.98 / $101.23
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $83.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.18 / $89.19 / $89.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $65.11 / $89.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.35 / $109.74 / $146.32
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $77.34 / $142.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.00 / $160.15 / $203.09
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.80 / $91.63 / $152.41
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.80 / $91.63 / $152.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.79 / $60.83 / $93.18