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Washington, DC 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
$76.87 / $76.87 / $76.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.87 / $76.87 / $76.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.85 / $104.85 / $128.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $78.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.08 / $122.08 / $372.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $93.70 / $140.79