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Massachusetts rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.30 / $1,088.30 / $1,088.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.30 / $1,088.30 / $1,458.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,525.50 / $4,811.43 / $9,963.20
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.38 / $1,601.78 / $2,432.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,643.74 / $3,216.41 / $4,142.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.00 / $2,210.04 / $2,210.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,440.73 / $1,746.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $2,803.50
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
$2,016.70 / $2,016.70 / $2,117.54
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.88 / $1,186.88 / $1,186.88
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,909.27 / $9,963.20 / $9,963.20
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.98 / $1,331.43 / $2,432.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.32 / $1,331.43 / $2,016.70