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West Virginia rates for HCPCS L8020

Breast prosthesis, mastectomy form

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $138.04 / $229.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $371.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $158.49 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $251.19