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Vermont rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $47.86 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $50.12 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $37.15 / $50.12
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $87.10 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $53.70 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $66.07 / $186.21