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Vermont 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
$51.12 / $57.02 / $61.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.94 / $151.94 / $151.94
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 / $107.14 / $114.51
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $153.94
MVP Health Care
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 / $107.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $111.26 / $217.12