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Virginia rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,258.21 / $2,258.21 / $2,282.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.36 / $2,258.21 / $2,353.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,281.76 / $4,281.76 / $4,547.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,635.75 / $2,635.75 / $3,294.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,675.00 / $2,675.00 / $2,926.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $1,787.62 / $2,448.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,997.23 / $3,853.58 / $5,138.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,262.19 / $2,633.36 / $4,804.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,467.00 / $5,624.12 / $7,132.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,345.85 / $3,231.41 / $5,110.20
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,345.85 / $3,231.41 / $5,110.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,955.12 / $2,136.13 / $3,100.81