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Virginia rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.11 / $312.11 / $315.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.19 / $312.11 / $373.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.78 / $591.78 / $628.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.88 / $359.88 / $465.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.00 / $317.00 / $404.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $400.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.25 / $532.60 / $710.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $363.96 / $673.65
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.00 / $777.31 / $985.72
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$324.23 / $444.73 / $739.73
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.23 / $444.73 / $739.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.00 / $295.24 / $454.95