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Massachusetts rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $56.23 / $125.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $131.83 / $616.60
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $131.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $223.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $114.82 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $74.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $69.18
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
$112.20 / $112.20 / $169.82
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $131.83 / $616.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $144.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $72.44 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $72.44 / $112.20