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Massachusetts rates for HCPCS L5673

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.73 / $413.73 / $413.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.73 / $413.73 / $701.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.18 / $2,672.01 / $4,467.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.13 / $682.76 / $924.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.04 / $840.16 / $840.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $695.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $1,099.88
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
$766.66 / $766.66 / $804.99
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.33 / $1,247.33 / $1,247.33
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.66 / $668.71 / $668.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,926.15 / $4,467.28 / $4,467.28
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.88 / $506.15 / $924.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.39 / $506.15 / $802.02