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West Virginia rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $181.97 / $309.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $501.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $588.84 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $1,778.28
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $380.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $302.00