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West Virginia rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.21 / $801.21 / $801.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.41 / $766.81 / $836.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,008.07 / $1,984.07 / $2,714.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.07 / $1,085.60 / $1,763.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $1,847.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $7,742.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.64 / $795.60 / $1,289.51