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Virginia rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,823.65 / $1,823.65 / $1,843.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,625.92 / $1,823.65 / $2,114.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,457.80 / $3,457.80 / $3,672.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.03 / $2,055.03 / $2,568.98
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,854.00 / $1,854.00 / $2,363.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $2,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $2,400.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.46 / $3,112.02 / $4,149.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.63 / $2,133.67 / $3,936.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.00 / $4,541.84 / $5,759.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.43 / $2,609.57 / $4,126.82
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,894.43 / $2,609.57 / $4,126.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.72 / $1,725.06 / $2,526.89