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Massachusetts rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.29 / $96.29 / $96.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.58 / $96.29 / $152.77
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.75 / $381.00 / $1,239.66
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.65 / $154.88 / $215.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.47 / $127.47 / $378.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.74 / $185.25 / $185.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $127.47 / $154.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $226.88
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
$178.43 / $178.43 / $187.35
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.71 / $127.71 / $127.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.33 / $1,239.66 / $1,239.66
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.08 / $117.80 / $215.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $117.80 / $215.21