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West Virginia rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,442.35 / $1,442.35 / $1,442.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.25 / $1,442.35 / $1,906.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.24 / $3,970.93 / $5,147.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.93 / $2,116.41 / $3,628.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $3,795.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $15,906.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.45 / $2,049.89 / $2,445.75