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Vermont rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.69 / $39.54 / $45.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.55 / $65.55 / $65.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $69.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $40.84 / $49.79
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $69.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $40.84 / $51.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.03 / $48.01 / $93.68