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Massachusetts rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,047.13 / $2,041.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $10,000.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,584.89 / $2,238.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,884.03 / $3,801.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,202.26
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,951.21
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $10,000.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,659.59 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1,071.52 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,202.26 / $1,905.46