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Virginia rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.87 / $335.87 / $339.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.95 / $335.87 / $401.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.84 / $636.84 / $676.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.54 / $386.54 / $497.90
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.00 / $341.00 / $435.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.41 / $397.94 / $397.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $290.50 / $397.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.79 / $573.16 / $764.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.11 / $391.66 / $724.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.00 / $836.50 / $1,060.78
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.91 / $478.58 / $796.05
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.91 / $478.58 / $796.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.10 / $317.70 / $489.58