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Vermont rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,230.27
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,949.84 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,862.09 / $5,248.07