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West Virginia rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $380.19 / $630.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,023.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $446.68 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $467.74 / $616.60