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Massachusetts rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $177.83 / $371.54
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $389.05 / $1,995.26
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $389.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $218.78
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
$331.13 / $331.13 / $501.19
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $389.05 / $1,995.26
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $288.40 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $239.88 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $239.88 / $331.13