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Virginia rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.03 / $118.03 / $119.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.82 / $118.03 / $134.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.79 / $223.79 / $237.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.93 / $136.93 / $177.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $120.00 / $152.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $149.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.65 / $201.41 / $268.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.08 / $141.96 / $261.68
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $293.95 / $372.77
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.61 / $168.89 / $279.74
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.61 / $168.89 / $279.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.99 / $111.65 / $172.04