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Vermont rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $128.82 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $40.74 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $186.21 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $138.04
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $223.87 / $281.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $158.49 / $478.63