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Vermont rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $104.71 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $120.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $177.83 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $104.71 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $134.90 / $380.19