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Vermont rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.38 / $116.64 / $130.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.05 / $172.37 / $502.98
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.37 / $173.47 / $303.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $175.32 / $554.61