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West Virginia rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,958.20 / $1,958.20 / $1,958.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,958.20 / $1,958.20 / $2,443.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.66 / $5,391.14 / $6,988.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,595.73 / $3,073.18 / $5,268.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $5,144.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $21,424.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,992.28 / $2,763.20 / $3,335.38