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Virginia rates for HCPCS L5722

Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.76 / $601.76 / $608.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.45 / $601.76 / $660.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.99 / $1,140.99 / $1,211.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.00 / $659.00 / $844.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $612.00 / $779.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.29 / $875.29 / $875.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $638.96 / $875.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.69 / $1,026.89 / $1,369.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $721.22 / $1,298.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $1,498.69 / $1,900.52
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.11 / $861.10 / $1,361.75
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.11 / $861.10 / $1,361.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.82 / $569.23 / $833.09