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Vermont rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $426.58
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $616.60 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $398.11 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $588.84 / $1,659.59