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Vermont rates for HCPCS L3967

Shoulder Elbow Wrist Hand Orthosis Abduction Positioning (Airplane Design) Thoracic Component And Support Bar Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.00 / $1,036.00 / $1,195.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,124.48 / $1,586.60
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,540.39
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,540.39 / $1,586.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.34 / $1,257.59 / $2,454.30