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Vermont rates for HCPCS L5699

All Lower Extremity Prostheses Shoulder Harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.28 / $141.28 / $163.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $212.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $139.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $212.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $139.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.65 / $240.72 / $240.72