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Massachusetts rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $645.65
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $707.95 / $3,090.30
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $501.19 / $707.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $616.60 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
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
$602.56 / $602.56 / $912.01
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $707.95 / $3,090.30
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $524.81 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $426.58 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $602.56