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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
$229.09 / $229.09 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $426.58
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $549.54 / $2,344.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $380.19 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $309.03
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $707.95
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $549.54 / $2,344.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $407.38 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $302.00 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $302.00 / $467.74