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Vermont rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $91.20 / $112.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $107.15
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $154.88 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $104.71 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $141.25 / $389.05