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Vermont rates for HCPCS L5628

Addition to lower extremity, test socket, hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $346.74 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $501.19
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $489.78 / $1,380.38