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Vermont rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,230.27
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,621.81 / $4,466.84