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Massachusetts rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.85 / $126.85 / $126.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $126.85 / $169.95
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.88 / $479.18 / $1,379.02
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.41 / $186.88 / $283.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.93 / $167.93 / $498.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.11 / $257.60 / $257.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $167.93 / $203.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $252.38
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
$235.06 / $235.06 / $246.81
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.34 / $138.34 / $138.34
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.18 / $1,379.02 / $1,379.02
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.63 / $155.18 / $283.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.63 / $155.18 / $235.06