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West Virginia rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.49 / $1,034.49 / $1,034.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.36 / $990.07 / $1,069.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,477.46 / $2,703.24 / $3,504.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.56 / $1,591.11 / $2,727.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $2,663.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $1,179.41 / $10,313.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.23 / $1,045.41 / $1,567.23