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New Hampshire 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
$61.57 / $61.57 / $73.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.57 / $77.30 / $82.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.82 / $187.82 / $222.64
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 / $114.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.07 / $152.07 / $469.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.86 / $89.25 / $100.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $93.70 / $111.26
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.66 / $154.74 / $196.94