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Vermont rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.44 / $402.44 / $464.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $606.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $447.75
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $606.14
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $420.01 / $447.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.29 / $505.25 / $953.38