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West Virginia rates for HCPCS L4350

Ankle Control Orthosis Stirrup Style Rigid Includes Any Type Interface (E.G. Pneumatic Gel)Prefabricated Off-The-Shelf (Revised 01/01/14) D 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.26 / $64.08 / $64.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.31 / $58.26 / $62.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.76 / $135.31 / $174.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.93 / $142.15 / $261.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.22 / $73.06 / $138.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.80 / $68.22 / $551.07
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.79 / $390.79 / $390.79
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.14 / $76.14 / $76.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.11 / $56.26 / $93.76