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Massachusetts rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.83 / $286.83 / $286.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.83 / $286.83 / $474.06
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.07 / $1,127.93 / $3,076.44
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.10 / $458.52 / $641.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.72 / $379.72 / $1,127.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.87 / $582.48 / $582.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.72 / $482.50 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $895.88
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
$531.52 / $531.52 / $558.10
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.74 / $388.74 / $388.74
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,568.50 / $3,076.44 / $3,076.44
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.44 / $350.91 / $641.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $240.92 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.33 / $350.91 / $598.34