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Vermont rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.65 / $73.65 / $84.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.10 / $122.10 / $122.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $106.64
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $106.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $103.83 / $174.46