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Vermont rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.89 / $184.89 / $213.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.54 / $306.54 / $306.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $278.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $235.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $278.45
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $235.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.02 / $239.30 / $437.99