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Vermont rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,454.71 / $2,951.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,884.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,398.83 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $3,801.89 / $10,471.29