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Vermont rates for HCPCS L3762

Elbow Orthosis Rigid Without Joints Includes Soft Interface Material Prefabricated Off-The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.94 / $56.16 / $64.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.31 / $133.31 / $154.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.10 / $93.10 / $93.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $70.16
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $383.66
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $65.81 / $71.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.79 / $68.17 / $133.05