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West Virginia rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$322.77 / $322.77 / $322.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.77 / $322.77 / $347.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.86 / $822.81 / $1,151.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.49 / $460.78 / $689.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $734.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $3,077.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.75 / $400.70 / $547.32