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West Virginia rates for HCPCS L3650

Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $42.57 / $319.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.65 / $38.70 / $39.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.69 / $93.64 / $131.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.19 / $52.44 / $79.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $69.00 / $86.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $46.70 / $362.71
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.61 / $345.61 / $345.61
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.58 / $50.58 / $50.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $74.09 / $74.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.34 / $37.36 / $62.29