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Vermont rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $3,715.35
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,248.07 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,235.94 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $4,466.84 / $12,302.69