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Massachusetts rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.22 / $307.22 / $307.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.39 / $307.22 / $411.60
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.11 / $1,070.54 / $2,777.21
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.63 / $533.63 / $686.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$406.72 / $406.72 / $1,207.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.46 / $623.89 / $623.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $406.72 / $492.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $611.25
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
$569.30 / $569.30 / $597.78
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.04 / $335.04 / $335.04
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.54 / $2,777.21 / $2,777.21
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.08 / $375.86 / $686.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.70 / $375.86 / $686.67