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Vermont rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $60.26 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $64.57
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $100.00 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $64.57 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $95.50 / $269.15