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Vermont rates for HCPCS L5613

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with hydraulic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,913.85 / $1,913.85 / $2,208.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $2,882.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $1,959.86
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $2,882.56
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $1,959.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.45 / $3,159.24 / $3,260.99