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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
$338.12 / $338.12 / $390.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $509.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.50 / $452.88 / $526.19
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $509.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.50 / $493.58 / $526.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.66 / $520.70 / $801.00