go back

Vermont rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $2,041.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,737.80
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $2,187.76 / $6,165.95