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Massachusetts rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.13 / $56.13 / $56.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.83 / $56.13 / $75.20
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.00 / $227.93 / $610.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.18 / $97.50 / $125.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.31 / $74.31 / $220.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.53 / $113.99 / $113.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $74.31 / $90.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $60.21 / $130.13
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
$104.02 / $104.02 / $109.22
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.21 / $61.21 / $61.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.93 / $610.23 / $610.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.07 / $68.67 / $125.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.91 / $68.67 / $104.02