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Massachusetts rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.89 / $231.89 / $231.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.11 / $231.89 / $332.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.91 / $960.80 / $2,322.98
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.37 / $331.91 / $518.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.98 / $306.98 / $911.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.28 / $470.91 / $470.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.98 / $372.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $548.63
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
$429.72 / $429.72 / $451.21
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.88 / $252.88 / $252.88
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.80 / $2,322.98 / $2,322.98
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.59 / $283.70 / $518.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.59 / $283.70 / $429.72