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Virginia rates for HCPCS L5850

Addition, endoskeletal system, above knee (AK) or hip disarticulation, knee extension assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.08 / $84.08 / $84.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.97 / $84.08 / $96.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.41 / $159.41 / $169.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.24 / $93.24 / $116.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $108.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $99.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $72.50 / $99.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.59 / $143.47 / $191.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.45 / $98.37 / $181.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.00 / $209.39 / $265.52
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.35 / $119.81 / $199.26
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.35 / $119.81 / $199.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.89 / $79.53 / $119.81