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Virginia rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.84 / $114.84 / $116.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $114.84 / $130.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.74 / $217.74 / $231.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.08 / $132.08 / $172.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.00 / $117.00 / $148.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.39 / $140.85 / $140.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $140.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.41 / $195.97 / $261.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $138.11 / $247.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $286.01 / $362.69
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.29 / $163.63 / $272.18
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.29 / $163.63 / $272.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.18 / $108.63 / $167.39