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Vermont rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $363.08 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $436.52
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $645.65 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $489.78 / $1,380.38