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Virginia rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.13 / $365.13 / $369.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.35 / $365.13 / $395.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.31 / $692.31 / $735.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.80 / $420.80 / $526.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.00 / $387.97 / $473.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.60 / $432.60 / $432.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.80 / $315.80 / $432.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.62 / $623.08 / $830.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.98 / $425.78 / $788.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.00 / $909.35 / $1,153.16
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.30 / $522.48 / $865.39
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.30 / $522.48 / $865.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.79 / $456.41 / $520.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.89 / $345.39 / $532.23