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Massachusetts rates for HCPCS L5677

Additions To Lower Extremity Below Knee Knee Joints Polycentric Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.76 / $344.76 / $344.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.25 / $344.76 / $496.85
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.23 / $1,383.28 / $3,747.94
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.58 / $507.23 / $770.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.40 / $456.40 / $1,355.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.67 / $700.11 / $700.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $456.40 / $553.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $772.13
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
$638.86 / $638.86 / $670.80
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.99 / $375.99 / $375.99
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.28 / $3,747.94 / $3,747.94
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.24 / $421.78 / $770.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.22 / $485.04 / $638.86