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Massachusetts rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.43 / $174.43 / $174.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.43 / $174.43 / $270.62
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.50 / $828.25 / $2,187.42
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.38 / $274.35 / $389.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$423.73 / $515.51 / $663.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.55 / $354.22 / $354.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.91 / $232.98 / $279.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $535.88
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
$323.22 / $323.22 / $339.38
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.29 / $220.29 / $220.29
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.29 / $220.29 / $262.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.49 / $2,187.42 / $2,187.42
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.94 / $213.39 / $389.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.98 / $213.39 / $389.85