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Massachusetts rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $70.79 / $144.54
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $147.91 / $776.25
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $109.65 / $147.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $100.00
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
$125.89 / $125.89 / $190.55
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $147.91 / $776.25
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $112.20 / $162.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $93.33 / $169.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $93.33 / $125.89