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Vermont rates for HCPCS L5670

Addition to lower extremity, below knee (BK), molded supracondylar suspension (PTS or similar)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $218.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $331.13 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $213.80 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $257.04 / $724.44