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Vermont rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.09 / $462.09 / $533.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.07 / $766.07 / $766.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $695.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $499.68 / $587.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $695.96
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $587.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.93 / $602.86 / $1,094.68