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West Virginia rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $363.08 / $562.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $776.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $380.19 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $416.87 / $562.34