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West Virginia rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.34 / $1,176.34 / $1,176.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.67 / $1,176.34 / $1,278.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,861.20 / $3,402.80 / $4,318.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.33 / $2,004.37 / $3,436.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $3,355.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,800.00 / $12,317.37
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.90 / $1,721.90 / $1,919.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.82 / $1,592.55 / $1,994.70