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West Virginia rates for HCPCS L1210

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lateral thoracic extension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.29 / $152.29 / $152.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.97 / $145.75 / $152.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.61 / $397.95 / $515.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.61 / $206.35 / $353.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.69 / $190.69 / $378.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.19 / $190.69 / $1,585.30
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.85 / $196.85 / $196.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.26 / $155.07 / $245.11