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Vermont rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.07 / $436.07 / $503.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $656.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $446.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $656.79
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $446.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.20 / $529.34 / $1,033.05