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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
$320.35 / $320.35 / $369.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.50 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.83 / $458.77 / $514.80
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.50 / $499.82 / $499.82
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.83 / $499.82 / $514.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.34 / $388.88 / $758.91