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West Virginia rates for HCPCS L7401

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.25 / $198.25 / $198.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.50 / $198.25 / $213.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$270.70 / $545.80 / $707.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.80 / $291.54 / $499.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $488.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $267.94 / $1,986.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.70 / $257.87 / $336.16