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West Virginia rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.64 / $408.64 / $408.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.94 / $391.09 / $512.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.03 / $1,067.82 / $1,384.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.14 / $662.34 / $1,135.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $1,108.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $4,278.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.74 / $422.81 / $657.69