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Vermont rates for HCPCS L5656

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.38 / $219.38 / $253.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.41 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $277.23
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.41 / $335.84 / $335.84
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $277.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.49 / $266.30 / $519.70