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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
$190.55 / $239.88 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $288.40
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $426.58 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $323.59 / $912.01