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Virginia rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.50 / $354.50 / $358.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.50 / $354.50 / $403.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.17 / $672.17 / $713.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.90 / $409.90 / $519.28
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.00 / $376.68 / $459.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.30 / $420.01 / $420.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $420.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.52 / $604.95 / $806.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $413.39 / $765.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.00 / $882.90 / $1,119.61
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.26 / $505.14 / $840.21
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.26 / $505.14 / $840.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.52 / $335.33 / $516.74