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West Virginia rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.49 / $413.49 / $413.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.28 / $413.49 / $460.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.74 / $1,138.36 / $1,475.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.11 / $597.41 / $1,024.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $1,029.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $4,314.62
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.91 / $590.27 / $674.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.68 / $558.92 / $701.14