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Massachusetts rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $251.19 / $457.09
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $524.81 / $2,344.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $363.08 / $524.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $446.68 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $363.08
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
$446.68 / $446.68 / $676.08
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $524.81 / $2,344.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $389.05 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $331.13 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $331.13 / $446.68