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West Virginia rates for HCPCS L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,738.05 / $10,738.05 / $10,738.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,643.36 / $10,738.05 / $11,549.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,662.63 / $29,562.98 / $38,322.37
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,234.03 / $15,790.52 / $27,069.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $26,435.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $14,513.81 / $107,604.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,924.91 / $13,968.01 / $18,208.18