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Virginia rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,549.30 / $11,549.30 / $11,672.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,665.35 / $11,549.30 / $12,037.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,898.50 / $21,898.50 / $23,256.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,489.26 / $12,489.26 / $15,612.82
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,168.77 / $13,168.77 / $14,969.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $14,513.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $14,513.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,328.95 / $19,708.65 / $26,278.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,455.32 / $13,467.97 / $24,570.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,826.18 / $28,763.78 / $36,475.81
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,397.66 / $16,440.39 / $23,938.75
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,397.66 / $16,440.39 / $23,938.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,874.11 / $10,924.91 / $16,456.84