go back

Vermont rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,995.26 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,630.27
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,311.31 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,630.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,570.40 / $7,079.46