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Virginia rates for HCPCS L5822

Addition Endoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.36 / $1,179.36 / $1,191.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.44 / $1,179.36 / $1,207.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.17 / $2,236.17 / $2,374.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.91 / $1,242.91 / $1,553.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,199.00 / $1,199.00 / $1,528.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $1,367.82 / $1,367.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.51 / $998.51 / $1,367.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.33 / $2,012.56 / $2,683.42
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.29 / $1,375.30 / $2,509.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.00 / $2,937.23 / $3,724.75
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.14 / $1,680.51 / $2,668.83
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.14 / $1,680.51 / $2,668.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.93 / $1,347.44 / $1,536.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.31 / $1,115.59 / $1,600.49