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West Virginia rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $131.83 / $218.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $331.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $165.96 / $218.78