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Vermont rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $257.04 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $316.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $416.87 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $245.47 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $398.11 / $1,096.48