| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $84.02 | $88.44 | $95.21 | |
Cigna
| Facility | $170.15 | $170.15 | $170.15 | |
Cigna
| Professional | $124.21 | $124.21 | $170.15 | |
United
| Professional | $67.90 | $109.12 | $169.74 |
Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $84.02 | $88.44 | $95.21 | |
Cigna
| Facility | $170.15 | $170.15 | $170.15 | |
Cigna
| Professional | $124.21 | $124.21 | $170.15 | |
United
| Professional | $67.90 | $109.12 | $169.74 |