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West Virginia rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $218.78 / $380.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $602.56
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $275.42 / $363.08