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Virginia rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.47 / $120.47 / $121.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.74 / $120.47 / $123.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.41 / $228.41 / $242.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.12 / $120.12 / $154.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $122.00 / $156.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.10 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $122.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.88 / $205.57 / $274.08
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $140.94 / $256.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.00 / $300.02 / $380.47
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.15 / $171.66 / $285.51
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.15 / $171.66 / $285.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.00 / $113.95 / $163.49