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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
$251.19 / $331.13 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $407.38
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $389.05 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $436.52 / $1,230.27