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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
$323.59 / $426.58 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $446.68
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $691.83 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $338.84 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $676.08 / $1,862.09