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Massachusetts rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $123.03 / $295.12
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $295.12 / $1,412.54
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $204.17 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $251.19 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $165.96 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $147.91
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
$251.19 / $251.19 / $380.19
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $295.12 / $1,412.54
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $204.17 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $165.96 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $165.96 / $251.19