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Vermont rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.05 / $385.05 / $444.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.37 / $638.37 / $638.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $579.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $416.08 / $516.02
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.05 / $440.05 / $579.92
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $440.05 / $516.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.43 / $502.37 / $912.17