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West Virginia rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,486.88 / $2,486.88 / $2,486.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,486.88 / $2,486.88 / $2,884.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,313.23 / $6,846.63 / $8,875.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,296.53 / $3,568.10 / $6,116.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $6,353.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $26,627.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,477.37 / $3,367.98 / $4,216.93