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Vermont rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.93 / $285.93 / $329.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.05 / $474.05 / $474.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $430.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $365.15
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $430.66
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $365.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $440.33 / $677.36