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West Virginia rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.30 / $20.30 / $20.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.66 / $19.44 / $23.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.56 / $51.77 / $68.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.56 / $27.52 / $45.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $48.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $202.58
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.52 / $27.52 / $27.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.08 / $19.96 / $32.69