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Massachusetts rates for HCPCS L5655

Addition To Lower Extremity Socket Insert Below Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.54 / $165.54 / $165.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.54 / $165.54 / $248.47
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.99 / $693.71 / $2,016.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.61 / $253.14 / $370.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.14 / $219.14 / $650.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.89 / $336.18 / $336.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.14 / $221.07 / $265.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $396.00
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
$306.77 / $306.77 / $322.11
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.28 / $214.28 / $214.28
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.71 / $2,016.23 / $2,016.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.00 / $202.51 / $370.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.83 / $202.51 / $370.01