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Vermont rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $128.82 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $151.36
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $229.09 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $218.78 / $602.56