go back

Massachusetts rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.73 / $221.73 / $221.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.73 / $221.73 / $362.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.95 / $842.33 / $2,323.85
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.40 / $345.30 / $495.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.52 / $293.52 / $871.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.53 / $450.26 / $450.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.52 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $635.25
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
$410.87 / $410.87 / $431.41
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.25 / $277.25 / $277.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.40 / $2,323.85 / $2,323.85
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.23 / $271.26 / $495.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.72 / $271.26 / $469.82