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West Virginia rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,437.13 / $2,437.13 / $2,437.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,415.64 / $2,437.13 / $2,621.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,327.88 / $6,709.66 / $8,697.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,230.58 / $3,583.87 / $6,143.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $5,999.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $24,422.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,479.54 / $3,170.22 / $3,985.08