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Massachusetts rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.58 / $302.58 / $302.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.58 / $303.80 / $524.04
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$619.62 / $1,954.28 / $3,169.20
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.95 / $499.37 / $676.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.59 / $412.59 / $1,225.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.82 / $614.47 / $614.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.21 / $436.96 / $485.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $436.96 / $783.00
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
$560.72 / $560.72 / $588.76
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.16 / $441.16 / $441.16
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,371.16 / $3,169.20 / $3,169.20
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.52 / $370.18 / $676.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.77 / $370.18 / $672.49