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Virginia rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.25 / $2,621.25 / $2,649.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.62 / $2,621.25 / $2,732.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,970.12 / $4,970.12 / $5,278.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,779.11 / $2,779.11 / $3,539.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,748.93 / $2,748.93 / $3,397.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $2,404.69 / $3,294.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,479.08 / $4,473.10 / $5,964.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.11 / $3,056.71 / $5,576.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,079.00 / $6,528.27 / $8,278.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,722.98 / $3,768.04 / $6,212.65
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,722.98 / $3,768.04 / $6,212.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,269.44 / $2,479.54 / $3,557.22