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Massachusetts rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.94 / $65.94 / $65.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.94 / $69.55 / $120.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.03 / $429.91 / $720.06
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.92 / $112.10 / $147.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.79 / $194.89 / $250.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.69 / $133.91 / $133.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $179.25
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
$122.20 / $122.20 / $128.31
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.19 / $110.19 / $110.19
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.94 / $720.06 / $720.06
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.95 / $80.66 / $147.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.87 / $80.66 / $150.91