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West Virginia rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.25 / $366.25 / $366.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.43 / $366.25 / $393.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.49 / $1,003.90 / $1,307.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.49 / $522.84 / $892.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $913.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $3,828.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.62 / $499.05 / $621.04