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Virginia rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$664.93 / $664.93 / $672.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.78 / $664.93 / $672.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,260.77 / $1,260.77 / $1,338.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.97 / $656.97 / $850.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.00 / $676.00 / $861.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $957.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $699.14 / $957.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.54 / $1,134.69 / $1,512.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.30 / $777.97 / $1,414.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.00 / $1,656.03 / $2,100.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.74 / $951.49 / $1,504.70
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.74 / $951.49 / $1,504.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.55 / $628.98 / $902.36