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Massachusetts rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.34 / $124.34 / $124.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.45 / $124.34 / $185.01
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.50 / $479.97 / $1,406.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.62 / $180.24 / $277.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.61 / $164.61 / $488.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.99 / $252.50 / $252.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $164.61 / $199.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $274.13
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
$230.42 / $230.42 / $241.94
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.10 / $141.10 / $141.10
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.97 / $1,406.43 / $1,406.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.79 / $152.12 / $277.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.08 / $296.08 / $296.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.79 / $152.12 / $252.96