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Vermont rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.54 / $107.54 / $124.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $161.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $130.38
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $161.97
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $130.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.23 / $165.62 / $254.77