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West Virginia rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.14 / $321.14 / $321.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.31 / $321.14 / $345.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.48 / $884.14 / $1,146.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.70 / $472.21 / $809.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $790.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $3,218.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.89 / $417.73 / $544.54