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Virginia rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,917.83 / $14,917.83 / $15,076.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,776.05 / $14,917.83 / $16,550.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,285.52 / $28,285.52 / $30,039.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,411.83 / $17,411.83 / $21,766.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,755.45 / $16,755.45 / $19,335.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $11,826.18 / $16,200.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,799.86 / $25,456.97 / $33,942.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,350.18 / $17,396.11 / $31,736.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,442.14 / $37,153.17 / $47,114.53
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,174.71 / $21,346.84 / $32,103.28
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,174.71 / $21,346.84 / $32,103.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,568.35 / $34,568.35 / $41,482.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,934.33 / $14,111.33 / $20,244.52