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Vermont rates for HCPCS L5781

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,300.62 / $2,300.62 / $2,654.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,814.21 / $3,814.21 / $3,814.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $3,465.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,687.21 / $3,077.39
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $3,465.09
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $3,077.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.00 / $3,243.48 / $5,450.16