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West Virginia rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.85 / $267.85 / $267.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.48 / $267.85 / $288.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.77 / $737.41 / $955.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.05 / $393.91 / $675.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $659.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $2,694.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.51 / $348.42 / $454.18