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West Virginia rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.58 / $506.58 / $506.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.05 / $484.83 / $506.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.36 / $1,225.70 / $1,715.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.04 / $686.39 / $1,047.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $1,049.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $731.52 / $878.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.71 / $588.34 / $1,262.27