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Virginia rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.08 / $288.08 / $291.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.06 / $288.08 / $300.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.23 / $546.23 / $580.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.45 / $305.45 / $388.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.94 / $304.94 / $373.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $362.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.36 / $491.61 / $655.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $335.94 / $612.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $717.48 / $909.84
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.26 / $413.46 / $683.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.26 / $413.46 / $683.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.43 / $272.51 / $395.58