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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$55.36 / $66.41 / $91.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.55 / $358.67 / $424.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.63 / $126.62 / $169.85
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 / $107.42 / $153.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.37 / $100.06 / $156.16