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Connecticut rates for HCPCS L3675

Shoulder Orthosis Vest Type Abduction Restrainer Canvas Webbing Type Or Equal Prefabricated Off- The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.29 / $91.29 / $91.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.16 / $89.78 / $91.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.56 / $187.82 / $214.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.86 / $106.22 / $106.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $107.42
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.08 / $122.08 / $122.08
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.08 / $122.08 / $172.79
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.42 / $114.42 / $114.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.83 / $70.83 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.51 / $93.70 / $156.16