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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
$319.58 / $319.58 / $368.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $462.74
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $462.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.82 / $450.57 / $757.09