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Vermont rates for HCPCS L3917

Hand Orthosis Metacarpal Fracture Orthosis Pre- Fabricated Item That Has Been Trimmed Bent Moldemolded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.18 / $55.18 / $68.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $83.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $85.73 / $92.55
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.66 / $64.66 / $83.09
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.38 / $86.85 / $92.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.61 / $66.97 / $130.71