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Virginia rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,106.14 / $2,106.14 / $2,128.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,106.14 / $2,106.14 / $2,381.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,993.44 / $3,993.44 / $4,241.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.26 / $2,396.26 / $3,092.88
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,141.00 / $2,237.94 / $2,729.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $2,728.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $2,668.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,795.41 / $3,594.10 / $4,792.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.01 / $2,456.03 / $4,545.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,469.00 / $5,245.39 / $6,651.77
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.89 / $3,013.81 / $4,766.09
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.89 / $3,013.81 / $4,766.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,867.81 / $1,992.28 / $3,048.16