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West Virginia rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $123.03 / $199.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $302.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $154.88 / $208.93