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Massachusetts rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.59 / $1,713.59 / $1,713.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.25 / $1,713.59 / $2,541.53
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $5,971.10 / $18,629.07
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,532.00 / $2,620.51 / $3,829.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,162.70 / $5,064.39 / $6,521.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,824.91 / $3,479.82 / $3,479.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $2,268.50 / $2,749.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,902.78 / $3,409.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,175.39 / $3,175.39 / $3,334.16
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,920.87 / $1,920.87 / $1,920.87
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,971.10 / $18,629.07 / $18,629.07
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.45 / $2,096.41 / $3,829.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,486.01 / $2,096.41 / $3,294.48