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Massachusetts rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.98 / $236.98 / $236.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.43 / $236.98 / $341.64
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.33 / $945.49 / $2,359.33
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.18 / $353.15 / $529.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.72 / $313.72 / $931.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.67 / $481.24 / $481.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $313.72 / $380.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $559.13
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
$439.13 / $439.13 / $461.09
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.45 / $276.45 / $276.45
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$978.76 / $2,359.33 / $2,359.33
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.86 / $289.92 / $529.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.07 / $289.92 / $529.66