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Vermont rates for HCPCS L7403

Addition To Upper Extremity Prosthesis Below Elbow/Wrist Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.74 / $211.74 / $244.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $209.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $209.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.46 / $326.08 / $501.63