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Virginia rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.96 / $138.96 / $140.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $138.96 / $146.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.49 / $263.49 / $279.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.22 / $148.22 / $190.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.30 / $160.30 / $180.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $159.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.44 / $237.14 / $316.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.51 / $162.06 / $294.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.37 / $346.09 / $438.88
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.36 / $202.57 / $336.63
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.36 / $202.57 / $336.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.61 / $131.44 / $188.59