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Vermont rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.05 / $385.05 / $444.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $581.29
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $581.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.42 / $628.67 / $656.07