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Vermont rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.01 / $90.66 / $136.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.80 / $125.80 / $125.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.40 / $75.40 / $75.40
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.14 / $15.92 / $129.76