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West Virginia rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom 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
$413.49 / $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
$528.74 / $528.74 / $1,029.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $4,314.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.68 / $558.92 / $732.46