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Massachusetts rates for HCPCS L5684

Addition to lower extremity, below knee, fork strap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.21 / $31.62 / $48.57
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.50 / $165.65 / $365.89
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $50.00 / $70.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.85 / $41.85 / $124.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $64.20 / $64.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.36 / $41.85 / $50.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.27 / $37.36 / $67.13
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
$58.59 / $58.59 / $61.52
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.71 / $36.71 / $36.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.80 / $365.89 / $365.89
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.26 / $38.68 / $70.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.82 / $38.68 / $59.32