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Vermont rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,055.14 / $5,055.14 / $5,832.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $4,856.05 / $6,851.68
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $6,652.12 / $6,652.12
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,856.05 / $6,652.12 / $6,851.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,445.37 / $6,933.27 / $11,975.64