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West Virginia rates for HCPCS L1990

Ankle Foot Orthosis Double Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Double Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.43 / $259.43 / $259.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.85 / $248.30 / $309.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.31 / $677.94 / $878.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.42 / $371.87 / $637.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $672.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $313.79 / $2,820.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.98 / $268.43 / $417.55