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West Virginia rates for HCPCS L3677

Shoulder Orthosis Shoulder Joint Design Without Joints May Include Soft Interface Straps Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $46.77 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $47.72 / $65.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $75.05 / $108.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.79 / $54.79 / $416.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.55 / $70.45 / $133.12