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Virginia rates for HCPCS L5987

All lower extremity prostheses, shank foot system with vertical loading pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,470.35 / $4,470.35 / $4,517.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.22 / $4,470.35 / $4,659.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,476.19 / $8,476.19 / $9,001.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,217.74 / $5,217.74 / $6,522.69
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,731.93 / $4,731.93 / $5,794.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $6,042.00 / $6,042.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $4,410.66 / $6,042.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,933.33 / $7,628.57 / $10,171.43
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,498.65 / $5,213.01 / $9,510.41
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,910.00 / $11,133.52 / $14,118.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,643.85 / $6,415.92 / $9,699.51
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,643.85 / $6,415.92 / $9,699.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,870.38 / $4,228.67 / $6,066.58