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Vermont rates for HCPCS L6621

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,479.11 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,778.28
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,630.27 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $2,041.74 / $5,623.41