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West Virginia rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$755.88 / $755.88 / $755.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.88 / $755.88 / $853.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,001.98 / $2,081.03 / $2,697.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.98 / $1,079.05 / $1,849.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $2,030.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $963.22 / $8,508.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.04 / $1,029.99 / $1,281.73