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Vermont rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $346.74 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $562.34 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $331.13 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $524.81 / $1,445.44