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Virginia rates for HCPCS L5814

Addition Endoskeletal Knee-Shin System Polycentric Hydraulic Swing Phase Control Mechanical Stance Phase Lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,307.87 / $2,307.87 / $2,332.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,131.25 / $2,307.87 / $2,405.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,375.92 / $4,375.92 / $4,647.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,693.73 / $2,693.73 / $3,367.43
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,442.92 / $2,442.92 / $2,991.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.67 / $2,502.67 / $2,502.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.95 / $1,826.95 / $2,502.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,063.14 / $3,938.33 / $5,251.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,289.96 / $2,691.29 / $4,909.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,535.00 / $5,747.80 / $7,288.87
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,397.44 / $3,312.30 / $5,222.58
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,397.44 / $3,312.30 / $5,222.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,973.13 / $2,183.10 / $3,131.95