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West Virginia rates for HCPCS L6890

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.11 / $100.11 / $100.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.11 / $100.11 / $109.72
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.69 / $275.60 / $361.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.69 / $142.91 / $244.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $279.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $1,169.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.84 / $142.27 / $169.74