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West Virginia rates for HCPCS L3977

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, 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
$1,041.11 / $1,041.11 / $1,041.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.54 / $996.41 / $1,041.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.30 / $2,720.56 / $3,526.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.90 / $1,453.10 / $2,491.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $2,432.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $9,902.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.24 / $1,021.58 / $1,675.63