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Massachusetts rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $87.10 / $234.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $194.98 / $1,000.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $144.54 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $109.65 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $165.96 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $109.65 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $107.15
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
$165.96 / $165.96 / $251.19
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $194.98 / $1,000.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $144.54 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $120.23 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $120.23 / $165.96