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Vermont rates for HCPCS L6694

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.09 / $462.09 / $533.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $385.98 / $563.66
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $563.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.52 / $711.61 / $1,094.68