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West Virginia rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.03 / $97.03 / $97.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.45 / $92.87 / $97.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.76 / $253.56 / $328.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.08 / $135.43 / $232.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $153.94 / $226.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $926.31
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.83 / $126.83 / $126.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.88 / $95.21 / $156.16